hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|WV,"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.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Preston Memorial Hospital,2024-06-04,2.0.0,Preston Memorial Hospital,"150 Memorial Dr Kingwood, WV 26537",311097818,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|4MOST|Commercial|negotiated_dollar,standard_charge|4MOST|Commercial|negotiated_percentage,standard_charge|4MOST|Commercial|negotiated_algorithm,estimated_amount|4MOST|Commercial,standard_charge|4MOST|Commercial|methodology,additional_payer_notes|4MOST|Commercial,standard_charge|ADVANTRA|MEDICARE|negotiated_dollar,standard_charge|ADVANTRA|MEDICARE|negotiated_percentage,standard_charge|ADVANTRA|MEDICARE|negotiated_algorithm,estimated_amount|ADVANTRA|MEDICARE,standard_charge|ADVANTRA|MEDICARE|methodology,additional_payer_notes|ADVANTRA|MEDICARE,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_AUTO|commercial|negotiated_dollar,standard_charge|AETNA_AUTO|commercial|negotiated_percentage,standard_charge|AETNA_AUTO|commercial|negotiated_algorithm,estimated_amount|AETNA_AUTO|commercial,standard_charge|AETNA_AUTO|commercial|methodology,additional_payer_notes|AETNA_AUTO|commercial,standard_charge|AETNA_MEDICAL_RENTAL|COMMERCIAL|negotiated_dollar,standard_charge|AETNA_MEDICAL_RENTAL|COMMERCIAL|negotiated_percentage,standard_charge|AETNA_MEDICAL_RENTAL|COMMERCIAL|negotiated_algorithm,estimated_amount|AETNA_MEDICAL_RENTAL|COMMERCIAL,standard_charge|AETNA_MEDICAL_RENTAL|COMMERCIAL|methodology,additional_payer_notes|AETNA_MEDICAL_RENTAL|COMMERCIAL,standard_charge|AETNA|MEDICARE|negotiated_dollar,standard_charge|AETNA|MEDICARE|negotiated_percentage,standard_charge|AETNA|MEDICARE|negotiated_algorithm,estimated_amount|AETNA|MEDICARE,standard_charge|AETNA|MEDICARE|methodology,additional_payer_notes|AETNA|MEDICARE,standard_charge|BLUE_CROSS_HIGHMARK_ACA|COMMERCIAL|negotiated_dollar,standard_charge|BLUE_CROSS_HIGHMARK_ACA|COMMERCIAL|negotiated_percentage,standard_charge|BLUE_CROSS_HIGHMARK_ACA|COMMERCIAL|negotiated_algorithm,estimated_amount|BLUE_CROSS_HIGHMARK_ACA|COMMERCIAL,standard_charge|BLUE_CROSS_HIGHMARK_ACA|COMMERCIAL|methodology,additional_payer_notes|BLUE_CROSS_HIGHMARK_ACA|COMMERCIAL,standard_charge|BLUE_CROSS_HIGHMARK_MEDICAID|MEDICAID|negotiated_dollar,standard_charge|BLUE_CROSS_HIGHMARK_MEDICAID|MEDICAID|negotiated_percentage,standard_charge|BLUE_CROSS_HIGHMARK_MEDICAID|MEDICAID|negotiated_algorithm,estimated_amount|BLUE_CROSS_HIGHMARK_MEDICAID|MEDICAID,standard_charge|BLUE_CROSS_HIGHMARK_MEDICAID|MEDICAID|methodology,additional_payer_notes|BLUE_CROSS_HIGHMARK_MEDICAID|MEDICAID,standard_charge|BLUE_CROSS_HIGHMARK_MEDICARE|MEDICARE|negotiated_dollar,standard_charge|BLUE_CROSS_HIGHMARK_MEDICARE|MEDICARE|negotiated_percentage,standard_charge|BLUE_CROSS_HIGHMARK_MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|BLUE_CROSS_HIGHMARK_MEDICARE|MEDICARE,standard_charge|BLUE_CROSS_HIGHMARK_MEDICARE|MEDICARE|methodology,additional_payer_notes|BLUE_CROSS_HIGHMARK_MEDICARE|MEDICARE,standard_charge|BLUE_CROSS_HIGHMARK_POS|COMMERCIAL|negotiated_dollar,standard_charge|BLUE_CROSS_HIGHMARK_POS|COMMERCIAL|negotiated_percentage,standard_charge|BLUE_CROSS_HIGHMARK_POS|COMMERCIAL|negotiated_algorithm,estimated_amount|BLUE_CROSS_HIGHMARK_POS|COMMERCIAL,standard_charge|BLUE_CROSS_HIGHMARK_POS|COMMERCIAL|methodology,additional_payer_notes|BLUE_CROSS_HIGHMARK_POS|COMMERCIAL,standard_charge|BLUE_CROSS_HIGHMARK_PPO|COMMERCIAL|negotiated_dollar,standard_charge|BLUE_CROSS_HIGHMARK_PPO|COMMERCIAL|negotiated_percentage,standard_charge|BLUE_CROSS_HIGHMARK_PPO|COMMERCIAL|negotiated_algorithm,estimated_amount|BLUE_CROSS_HIGHMARK_PPO|COMMERCIAL,standard_charge|BLUE_CROSS_HIGHMARK_PPO|COMMERCIAL|methodology,additional_payer_notes|BLUE_CROSS_HIGHMARK_PPO|COMMERCIAL,standard_charge|BLUE_CROSS_HIGHMARK_TRADITIONAL|COMMERCIAL|negotiated_dollar,standard_charge|BLUE_CROSS_HIGHMARK_TRADITIONAL|COMMERCIAL|negotiated_percentage,standard_charge|BLUE_CROSS_HIGHMARK_TRADITIONAL|COMMERCIAL|negotiated_algorithm,estimated_amount|BLUE_CROSS_HIGHMARK_TRADITIONAL|COMMERCIAL,standard_charge|BLUE_CROSS_HIGHMARK_TRADITIONAL|COMMERCIAL|methodology,additional_payer_notes|BLUE_CROSS_HIGHMARK_TRADITIONAL|COMMERCIAL,standard_charge|CARESOURCE_MEDICAID|MEDICAID|negotiated_dollar,standard_charge|CARESOURCE_MEDICAID|MEDICAID|negotiated_percentage,standard_charge|CARESOURCE_MEDICAID|MEDICAID|negotiated_algorithm,estimated_amount|CARESOURCE_MEDICAID|MEDICAID,standard_charge|CARESOURCE_MEDICAID|MEDICAID|methodology,additional_payer_notes|CARESOURCE_MEDICAID|MEDICAID,standard_charge|CARESOURCE_MEDICARE|MEDICARE|negotiated_dollar,standard_charge|CARESOURCE_MEDICARE|MEDICARE|negotiated_percentage,standard_charge|CARESOURCE_MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|CARESOURCE_MEDICARE|MEDICARE,standard_charge|CARESOURCE_MEDICARE|MEDICARE|methodology,additional_payer_notes|CARESOURCE_MEDICARE|MEDICARE,standard_charge|CIGNA|COMMERCIAL|negotiated_dollar,standard_charge|CIGNA|COMMERCIAL|negotiated_percentage,standard_charge|CIGNA|COMMERCIAL|negotiated_algorithm,estimated_amount|CIGNA|COMMERCIAL,standard_charge|CIGNA|COMMERCIAL|methodology,additional_payer_notes|CIGNA|COMMERCIAL,standard_charge|GEHA|COMMERCIAL|negotiated_dollar,standard_charge|GEHA|COMMERCIAL|negotiated_percentage,standard_charge|GEHA|COMMERCIAL|negotiated_algorithm,estimated_amount|GEHA|COMMERCIAL,standard_charge|GEHA|COMMERCIAL|methodology,additional_payer_notes|GEHA|COMMERCIAL,standard_charge|HEALTH_PLAN|COMMERCIAL|negotiated_dollar,standard_charge|HEALTH_PLAN|COMMERCIAL|negotiated_percentage,standard_charge|HEALTH_PLAN|COMMERCIAL|negotiated_algorithm,estimated_amount|HEALTH_PLAN|COMMERCIAL,standard_charge|HEALTH_PLAN|COMMERCIAL|methodology,additional_payer_notes|HEALTH_PLAN|COMMERCIAL,standard_charge|HEALTH_PLAN_MEDICAID|MEDICAID|negotiated_dollar,standard_charge|HEALTH_PLAN_MEDICAID|MEDICAID|negotiated_percentage,standard_charge|HEALTH_PLAN_MEDICAID|MEDICAID|negotiated_algorithm,estimated_amount|HEALTH_PLAN_MEDICAID|MEDICAID,standard_charge|HEALTH_PLAN_MEDICAID|MEDICAID|methodology,additional_payer_notes|HEALTH_PLAN_MEDICAID|MEDICAID,standard_charge|HEALTH_PLAN_MEDICARE|MEDICARE|negotiated_dollar,standard_charge|HEALTH_PLAN_MEDICARE|MEDICARE|negotiated_percentage,standard_charge|HEALTH_PLAN_MEDICARE|MEDICARE|negotiated_algorithm,estimated_amount|HEALTH_PLAN_MEDICARE|MEDICARE,standard_charge|HEALTH_PLAN_MEDICARE|MEDICARE|methodology,additional_payer_notes|HEALTH_PLAN_MEDICARE|MEDICARE,standard_charge|HUMANA|MEDICARE|negotiated_dollar,standard_charge|HUMANA|MEDICARE|negotiated_percentage,standard_charge|HUMANA|MEDICARE|negotiated_algorithm,estimated_amount|HUMANA|MEDICARE,standard_charge|HUMANA|MEDICARE|methodology,additional_payer_notes|HUMANA|MEDICARE,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|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_VA|MEDICARE|negotiated_dollar,standard_charge|UHC_VA|MEDICARE|negotiated_percentage,standard_charge|UHC_VA|MEDICARE|negotiated_algorithm,estimated_amount|UHC_VA|MEDICARE,standard_charge|UHC_VA|MEDICARE|methodology,additional_payer_notes|UHC_VA|MEDICARE,standard_charge|UNICARE|COMMERCIAL|negotiated_dollar,standard_charge|UNICARE|COMMERCIAL|negotiated_percentage,standard_charge|UNICARE|COMMERCIAL|negotiated_algorithm,estimated_amount|UNICARE|COMMERCIAL,standard_charge|UNICARE|COMMERCIAL|methodology,additional_payer_notes|UNICARE|COMMERCIAL,standard_charge|UPMC|MEDICARE|negotiated_dollar,standard_charge|UPMC|MEDICARE|negotiated_percentage,standard_charge|UPMC|MEDICARE|negotiated_algorithm,estimated_amount|UPMC|MEDICARE,standard_charge|UPMC|MEDICARE|methodology,additional_payer_notes|UPMC|MEDICARE,standard_charge|min,standard_charge|max,additional_generic_notes
INTENSIVE CARE,,,200,RC,,,Inpatient,,,1623,811.5,,1574.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,3075.19,100,,,per diem,Pays at per day rate,811.5,50,,,percent of total billed charges,Pays at 50% of total billed charges,811.5,50,,,percent of total billed charges,Pays at 50% of total billed charges,811.5,50,,,percent of total billed charges,Pays at 50% of total billed charges,3075.19,100,,,per diem,Pays at per day rate,5976,100,,,per diem,Pays at per day rate,3127.53,105,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,5976,100,,,per diem,Pays at per day rate,5976,100,,,per diem,Pays at per day rate,5976,100,,,per diem,Pays at per day rate,3038.17,102,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,1493.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,1541.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,1574.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,2978.6,100,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,1460.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,3075.19,100,,,per diem,Pays at per day rate,1166,100,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,90,3075.19,
TELEMETRY,,,206,RC,,,Inpatient,,,1529,764.5,,1483.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,3075.19,100,,,per diem,Pays at per day rate,764.5,50,,,percent of total billed charges,Pays at 50% of total billed charges,764.5,50,,,percent of total billed charges,Pays at 50% of total billed charges,764.5,50,,,percent of total billed charges,Pays at 50% of total billed charges,3075.19,100,,,per diem,Pays at per day rate,5976,100,,,per diem,Pays at per day rate,3127.53,105,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,5976,100,,,per diem,Pays at per day rate,5976,100,,,per diem,Pays at per day rate,5976,100,,,per diem,Pays at per day rate,3038.17,102,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,1406.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,1452.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,1483.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,2978.6,100,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,1376.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,3075.19,100,,,per diem,Pays at per day rate,1166,100,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,90,3075.19,
PRIVATE,,,120,RC,,,Inpatient,,,1310,655,,1270.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,3075.19,100,,,per diem,Pays at per day rate,655,50,,,percent of total billed charges,Pays at 50% of total billed charges,655,50,,,percent of total billed charges,Pays at 50% of total billed charges,655,50,,,percent of total billed charges,Pays at 50% of total billed charges,3075.19,100,,,per diem,Pays at per day rate,5976,100,,,per diem,Pays at per day rate,3127.53,105,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,5976,100,,,per diem,Pays at per day rate,5976,100,,,per diem,Pays at per day rate,5976,100,,,per diem,Pays at per day rate,3038.17,102,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,1205.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,1244.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,1270.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,2978.6,100,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,1179,90,,,percent of total billed charges,Pays at 90% of total billed charges,3075.19,100,,,per diem,Pays at per day rate,1166,100,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,90,3075.19,
SWING BED,,,180,RC,,,Inpatient,,,170,85,,164.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,3075.19,100,,,per diem,Pays at per day rate,85,50,,,percent of total billed charges,Pays at 50% of total billed charges,85,50,,,percent of total billed charges,Pays at 50% of total billed charges,85,50,,,percent of total billed charges,Pays at 50% of total billed charges,3075.19,100,,,per diem,Pays at per day rate,5976,100,,,per diem,Pays at per day rate,3127.53,105,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,5976,100,,,per diem,Pays at per day rate,5976,100,,,per diem,Pays at per day rate,5976,100,,,per diem,Pays at per day rate,3038.17,102,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,156.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,161.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,164.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,2978.6,100,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,,,,,Other,Not Separately reimbursable,3075.19,100,,,per diem,Pays at per day rate,1166,100,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,100,3075.19,
RESPITE,,,100,RC,,,Inpatient,,,203,101.5,,196.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,3075.19,100,,,per diem,Pays at per day rate,101.5,50,,,percent of total billed charges,Pays at 50% of total billed charges,101.5,50,,,percent of total billed charges,Pays at 50% of total billed charges,101.5,50,,,percent of total billed charges,Pays at 50% of total billed charges,3075.19,100,,,per diem,Pays at per day rate,5976,100,,,per diem,Pays at per day rate,3127.53,105,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,5976,100,,,per diem,Pays at per day rate,5976,100,,,per diem,Pays at per day rate,5976,100,,,per diem,Pays at per day rate,3038.17,102,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,186.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,192.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,196.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,2978.6,100,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,,,,,Other,Not Separately reimbursable,3075.19,100,,,per diem,Pays at per day rate,1166,100,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,100,3075.19,
CIRCAID PAC BAND LRG,2004115,CDM,131,RC,,,Inpatient,,,32.75,16.38,,31.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,3075.19,100,,,per diem,Pays at per day rate,16.38,50,,,percent of total billed charges,Pays at 50% of total billed charges,16.38,50,,,percent of total billed charges,Pays at 50% of total billed charges,16.38,50,,,percent of total billed charges,Pays at 50% of total billed charges,3075.19,100,,,per diem,Pays at per day rate,5976,100,,,per diem,Pays at per day rate,3127.53,105,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,5976,100,,,per diem,Pays at per day rate,5976,100,,,per diem,Pays at per day rate,5976,100,,,per diem,Pays at per day rate,3038.17,102,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,30.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,31.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,2978.6,100,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,,,,,Other,Not Separately reimbursable,3075.19,100,,,per diem,Pays at per day rate,1166,100,,,per diem,Pays at per day rate,3075.19,100,,,per diem,Pays at per day rate,100,3075.19,
"Complete blood cell count, with differential white blood cells, automated",1000114,CDM,300,RC,,,outpatient,,,79.5,39.75,,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,57.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.49,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,73.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,7.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.77,102.86,
.AUREOBASIDIUM PULLULANS-1001090,1000500,CDM,300,RC,,,outpatient,,,47,23.5,,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.38,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.17,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,43.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.98,102.86,
.THERMOACTIN SACCHARI-1001090,1000501,CDM,300,RC,,,outpatient,,,47,23.5,,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.74,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,43.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.18,102.86,
.ASPERGILLUS IGG - 1001090,1000502,CDM,300,RC,,,outpatient,,,47,23.5,,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.32,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,43.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.05,102.86,
.MICROPOLY FAENI - 1001090,1000503,CDM,300,RC,,,outpatient,,,47,23.5,,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.16,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.39,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,43.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,102.86,
.THERMOACTIN VULGARIS-1001090,1000504,CDM,300,RC,,,outpatient,,,47,23.5,,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.74,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,43.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.18,102.86,
.PIGEON ABS -1001090,1000505,CDM,300,RC,,,outpatient,,,47,23.5,,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.54,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,43.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.25,102.86,
LYME DISEASE AB W/ REFLEX,1000584,CDM,300,RC,,,outpatient,,,69.25,34.63,,67.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.76,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,62.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,55.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,45.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.99,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,63.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,65.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,67.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.03,102.86,
RETIC COUNT,1000601,CDM,300,RC,,,outpatient,,,67.25,33.63,,65.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,60.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,48.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,45.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,54.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,59.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,44.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.39,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,61.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,63.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,65.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,60.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.99,102.86,
FIBRINOGEN,1000603,CDM,300,RC,,,outpatient,,,72,36,,69.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.72,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.58,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,64.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.72,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,52.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,49.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.72,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,58.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.12,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,66.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,68.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.72,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.72,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.72,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,64.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.72,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.72,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.72,102.86,
VALPROIC ACID,1000607,CDM,300,RC,,,outpatient,,,149.25,74.63,,144.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,108.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,120.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.28,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,137.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,134.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.54,134.33,
Blood test to monitor for cancer,1000608,CDM,300,RC,,,outpatient,,,131.25,65.63,,127.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.04,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,118.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,95.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,105.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.09,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,120.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,124.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,127.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,118.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.81,118.13,
TESTOSTERONE TOTAL,1000609,CDM,300,RC,,,outpatient,,,216.75,108.38,,210.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,195.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,195.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,157.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,147.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,174.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,192.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,143.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.84,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,199.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,205.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,210.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,195.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.81,195.08,
CARCINOEMBRYONIC ANT,1000610,CDM,300,RC,,,outpatient,,,188.25,94.13,,182.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,169.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,169.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,136.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,128.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,151.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,151.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,166.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,124.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.6,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,173.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,178.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,182.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,122.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,169.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.96,169.43,
AMMONIA (MON GEN),1000611,CDM,300,RC,,,outpatient,,,122.25,61.13,,118.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,110.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,88.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,98.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.67,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,112.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,118.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,110.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.57,110.03,
HEPATITIS B CORE AB IGM,1000612,CDM,300,RC,,,outpatient,,,28.5,14.25,,27.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.2,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.89,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,26.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.77,102.86,
Blood test indicating infection with Hepatitis B,1000613,CDM,300,RC,,,outpatient,,,29,14.5,,28.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.27,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,26.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,102.86,
"HEP B SURFACE AB, QNT",1000614,CDM,300,RC,,,outpatient,,,36.25,18.13,,35.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,32.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.24,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,33.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.99,102.86,
HEP B SURFACE ANTIGEN,1000615,CDM,300,RC,,,outpatient,,,25.25,12.63,,24.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.95,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,23.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,10.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.33,102.86,
HEPATITIS A AB IGM,1000616,CDM,300,RC,,,outpatient,,,24,12,,23.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.76,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.2,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,22.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.26,102.86,
Blood test to determine infection with Hepatitis C,1000617,CDM,300,RC,,,outpatient,,,29,14.5,,28.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.26,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,26.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.27,102.86,
.BB ABO - MON,1000619,CDM,300,RC,,,outpatient,,,40,20,,38.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,36,90,,,percent of total billed charges,Pays at 90% of total billed charges,36,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.04,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,36.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,38,95,,,percent of total billed charges,Pays at 95% of total billed charges,38.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,26,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.99,102.86,
.BB RH TYPE,1000620,CDM,300,RC,,,outpatient,,,40,20,,38.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,36,90,,,percent of total billed charges,Pays at 90% of total billed charges,36,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.04,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,36.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,38,95,,,percent of total billed charges,Pays at 95% of total billed charges,38.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,26,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.99,102.86,
BB DIRECT COOMBS - MON,1000625,CDM,300,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.67,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.28,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.39,102.86,
"C DIFFICILE TOXIN GENE, A",1000627,CDM,300,RC,,,outpatient,,,278.5,139.25,,270.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,250.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,202.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,190.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,224.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,224.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,246.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,184.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,50.31,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,256.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,264.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,270.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,181.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,250.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,37.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.27,250.65,
"INFLUENZA A & B, PCR",1000630,CDM,300,RC,,,outpatient,,,523.75,261.88,,508.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,74.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,471.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,471.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,381.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,357.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,95.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,422.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,422.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,464.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,347.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,129.33,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,481.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,497.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,508.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,340.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,95.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,95.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,95.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,471.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,95.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90,471.38,
A procedure used to determine if fungi are present in an area of the body,1000631,CDM,306,RC,,,outpatient,,,168.25,84.13,,163.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.68,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,151.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,151.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,122.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,135.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,149.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,111.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.41,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,154.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,159.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,163.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,151.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,7.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.71,151.43,
Test of body fluid other than blood to assess for bacteria,1000633,CDM,300,RC,,,outpatient,,,87.5,43.75,,84.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,63.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,70.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.64,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,80.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,84.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,78.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.62,102.86,
Blood test to identify bacteria that may be contributing to symptoms in the gastrointestil tract,1000634,CDM,300,RC,,,outpatient,,,75.25,37.63,,72.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.18,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,67.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,54.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,60.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,49.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.74,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,69.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,72.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,67.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.44,102.86,
CULTURE ACID FAST W/SMEAR,1000637,CDM,300,RC,,,outpatient,,,166.25,83.13,,161.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,149.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,120.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,134.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.58,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,152.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,157.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,161.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,149.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,10.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.8,149.63,
CYTOLOGY URINE,1000638,CDM,311,RC,,,outpatient,,,145.25,72.63,,140.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,99.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,117.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,96.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,133.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.73,
Urine test,1000639,CDM,311,RC,,,outpatient,,,116.75,58.38,,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,107.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,105.08,
.CYTOLOGY SECRETIONS BRST,1000640,CDM,311,RC,,,outpatient,,,105,52.5,,101.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,63,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.68,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,94.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,63,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,71.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,69.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,85.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,96.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,99.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,101.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,63,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,63,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,63,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
CRP CARDIAC,1000642,CDM,300,RC,,,outpatient,,,27.5,13.75,,26.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.48,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,25.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.95,102.86,
TPO ABS,1000643,CDM,300,RC,,,outpatient,,,31,15.5,,30.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.64,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,28.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.55,102.86,
TPO ABS TSH CASCADE,1000644,CDM,300,RC,,,outpatient,,,31,15.5,,30.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.64,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,28.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.55,102.86,
THYROID STIMULATING IMM,1000645,CDM,300,RC,,,outpatient,,,199,99.5,,193.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,44.08,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,179.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,179.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,144.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,135.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,50.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,160.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,176.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,131.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,68.66,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,183.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,189.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,193.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,129.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,50.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,179.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,50.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.86,179.1,
Blood test to evaluate thyroid function,1000646,CDM,300,RC,,,outpatient,,,30.25,15.13,,29.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.29,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,27.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.14,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,27.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.18,102.86,
T3 REVERSE,1000647,CDM,300,RC,,,outpatient,,,77,38.5,,74.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.76,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.66,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.76,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,56.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.76,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,51.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.28,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,70.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,73.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.76,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.76,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.76,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.76,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.76,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.76,102.86,
CORTISOL (LC-004051),1000649,CDM,300,RC,,,outpatient,,,34.5,17.25,,33.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.13,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.01,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,31.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,32.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.3,102.86,
Blood test to if peptic ulcers are caused by a certain bacterium,1000650,CDM,300,RC,,,outpatient,,,52.75,26.38,,51.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.14,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.75,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,48.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.85,102.86,
Blood test to if peptic ulcers are caused by a certain bacterium,1000651,CDM,300,RC,,,outpatient,,,52.75,26.38,,51.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.14,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.75,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,48.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.85,102.86,
H PYLORI STOOL AG,1000653,CDM,300,RC,,,outpatient,,,143.5,71.75,,139.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,129.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,129.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,104.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,97.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,115.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.41,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,132.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,136.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,139.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,129.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.38,129.15,
SEX HORMONE BINDING GLOBULIN,1000654,CDM,300,RC,,,outpatient,,,57.5,28.75,,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.34,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,52.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,54.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,21.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.73,102.86,
CYCLOSPORINE BLOOD,1000655,CDM,300,RC,,,outpatient,,,65.25,32.63,,63.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.65,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,52.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,60.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,58.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.05,102.86,
Blood test to measure a type of estrogen in the blood,1000656,CDM,300,RC,,,outpatient,,,77,38.5,,74.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,56.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,51.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,37.72,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,70.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,73.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,27.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.94,102.86,
ESTROGEN TOTAL SERUM,1000657,CDM,300,RC,,,outpatient,,,65.25,32.63,,63.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,52.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.3,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,60.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,58.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,21.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.7,102.86,
PROGESTERONE,1000658,CDM,300,RC,,,outpatient,,,24,12,,23.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.08,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.16,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,22.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,20.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.86,102.86,
PROLACTIN,1000659,CDM,300,RC,,,outpatient,,,19.5,9.75,,18.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.79,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.16,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,17.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,19.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.55,102.86,
Test of hormone in the blood,1000660,CDM,300,RC,,,outpatient,,,26.5,13.25,,25.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,23.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.08,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,24.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.58,102.86,
DHEA,1000661,CDM,300,RC,,,outpatient,,,35,17.5,,33.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.9,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,31.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.11,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,32.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,25.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.27,102.86,
Blood test to measure an enzyme in the blood,1000662,CDM,300,RC,,,outpatient,,,178.75,89.38,,173.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,160.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,160.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,130.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,122,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,144.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,144.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,158.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,118.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.01,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,164.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,169.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,173.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,116.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,160.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,22.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.23,160.88,
Test of hormone in the blood,1000663,CDM,300,RC,,,outpatient,,,16,8,,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.04,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,14.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.4,102.86,
Test is used to measure the amount of the drug in the blood to determine whether the concentration has reached a therapeutic level and is below the to,1000664,CDM,300,RC,,,outpatient,,,149.5,74.75,,145.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.9,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,108.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,120.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.54,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,137.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,134.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.73,134.55,
Blood test to determine infection with Hepatitis C,1000665,CDM,300,RC,,,outpatient,,,54.5,27.25,,52.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,49.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,39.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,43.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.26,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,50.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,51.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,52.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.27,102.86,
MYCOPHENOLIC ACID & METABOLITE,1000666,CDM,300,RC,,,outpatient,,,306,153,,296.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.65,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,275.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,275.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,222.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,208.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,247,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,247,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,271.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,202.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,281.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,290.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,296.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,198.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,275.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.05,275.4,
Acute hepatitis panel,1000667,CDM,300,RC,,,outpatient,,,114.75,57.38,,111.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.29,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,103.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,83.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,92.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.3,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,105.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,103.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,47.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.63,103.28,
HEPATITIS BE ANTIGEN,1000668,CDM,300,RC,,,outpatient,,,19.5,9.75,,18.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,17.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,102.86,
HEP BE AB,1000669,CDM,300,RC,,,outpatient,,,29,14.5,,28.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.02,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.62,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,26.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.57,102.86,
HCV QNT PCR,1000670,CDM,300,RC,,,outpatient,,,859.75,429.88,,833.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.13,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,773.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,773.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,625.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,586.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,693.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,693.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,761.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,570.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,57.83,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,790.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,816.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,833.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,558.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,773.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.84,773.78,
HBV QNT D PCR,1000671,CDM,300,RC,,,outpatient,,,756.5,378.25,,733.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.13,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,680.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,680.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,550.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,516.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,610.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,610.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,670.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,501.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,57.83,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,695.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,718.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,733.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,491.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,680.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.84,680.85,
Blood test indicating infection with Hepatitis A,1000672,CDM,300,RC,,,outpatient,,,16,8,,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.73,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,14.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.39,102.86,
Blood test to determine the concentration of lead in the blood,1000673,CDM,300,RC,,,outpatient,,,14.25,7.13,,13.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.35,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,13.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.11,102.86,
Blood test to determine the concentration of lead in the blood,1000674,CDM,300,RC,,,outpatient,,,119.75,59.88,,116.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,107.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,87.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,81.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,96.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.35,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,110.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,113.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,107.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.11,107.78,
ZINC PLASMA,1000675,CDM,300,RC,,,outpatient,,,18.25,9.13,,17.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.38,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,16.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.39,102.86,
COPPER SERUM/PLASMA,1000676,CDM,300,RC,,,outpatient,,,62.25,31.13,,60.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.76,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,56.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,45.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,42.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.75,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,57.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,59.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,60.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,56.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.41,102.86,
CHROMIUM PLASMA,1000677,CDM,300,RC,,,outpatient,,,120.25,60.13,,116.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.57,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,108.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,87.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,97.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.38,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,110.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,108.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,20.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.28,108.23,
COBALT PLASMA,1000678,CDM,300,RC,,,outpatient,,,103.25,51.63,,100.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.04,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,92.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,75.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,70.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,83.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,68.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.65,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,94.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,98.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,100.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,92.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,21.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.96,102.86,
Blood test to if peptic ulcers are caused by a certain bacterium,1000679,CDM,300,RC,,,outpatient,,,52.75,26.38,,51.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.14,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.75,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,48.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.85,102.86,
"CORTISOL, FREE, URINE 24 HR",1000680,CDM,300,RC,,,outpatient,,,45,22.5,,43.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.48,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,40.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.56,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,41.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,42.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,43.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.71,102.86,
Blood test to determine existence of certain bacterium that causes syphilis,1000682,CDM,300,RC,,,outpatient,,,182.75,91.38,,177.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,132.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,124.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,147.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,161.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.87,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,168.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,173.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,177.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.24,164.48,
Blood test to screen for syphilis,1000683,CDM,300,RC,,,outpatient,,,11.5,5.75,,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.71,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.76,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,10.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,102.86,
LYME DISEASE IGM EARLY TEST,1000686,CDM,300,RC,,,outpatient,,,41.5,20.75,,40.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.76,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,37.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.99,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,38.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,39.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.03,102.86,
EBV AB TO EARLY ANTIGEN IGG,1000687,CDM,300,RC,,,outpatient,,,49.5,24.75,,48.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,44.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,33.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,39.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,32.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.71,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,45.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,47.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,48.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,44.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.12,102.86,
Blood test to determine if antibodies exist for rubella,1000688,CDM,300,RC,,,outpatient,,,17.75,8.88,,17.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,15.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.43,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,16.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.39,102.86,
Blood test to determine if antibodies exist for measles,1000689,CDM,300,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.16,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.39,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,102.86,
MUMPS AB IGG,1000692,CDM,300,RC,,,outpatient,,,16,8,,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.62,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,14.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.05,102.86,
VARICELLA ZOSTER IGM QNT,1000693,CDM,300,RC,,,outpatient,,,62.25,31.13,,60.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.16,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,56.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,45.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,42.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.39,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,57.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,59.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,60.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,56.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,102.86,
HERPES 1/2  IGM EIA,1000694,CDM,300,RC,,,outpatient,,,68,34,,65.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,61.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,54.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,45.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.43,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,62.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,65.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,61.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.39,102.86,
HSV 1/2 D PCR,1000695,CDM,300,RC,,,outpatient,,,503.25,251.63,,488.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,452.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,452.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,366.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,343.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,406.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,406.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,445.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,333.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,462.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,478.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,488.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,327.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,452.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,452.93,
CMV QNT PCR PLASMA,1000697,CDM,300,RC,,,outpatient,,,687.25,343.63,,666.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.13,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,618.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,618.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,500.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,469.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,554.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,554.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,608.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,455.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,57.83,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,632.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,652.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,666.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,446.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,618.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.84,618.53,
CMV ABS QNT IGM,1000698,CDM,300,RC,,,outpatient,,,30.25,15.13,,29.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.6,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,27.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.75,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,27.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.85,102.86,
Blood test to monitor for cytomegalovirus,1000699,CDM,300,RC,,,outpatient,,,23.75,11.88,,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.43,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,21.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.39,102.86,
CHLAMYDIA PNEUMONIAE PCR,1000700,CDM,300,RC,,,outpatient,,,488.75,244.38,,474.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,439.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,439.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,355.61,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,333.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,394.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,394.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,433.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,324.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,449.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,464.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,474.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,317.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,439.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,439.88,
BK VIRUS QNT D PCR,1000702,CDM,300,RC,,,outpatient,,,1247.5,623.75,,1210.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.13,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1122.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,1122.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,907.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,851.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,1006.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1006.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1105.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,827.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,57.83,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,1147.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,1185.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,1210.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,810.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,1122.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.84,1122.75,
ROTAVIRUS DIRECT DETECTION,1000703,CDM,300,RC,,,outpatient,,,48.25,24.13,,46.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,43.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.17,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,44.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,45.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,46.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,43.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.98,102.86,
ADENOVIRUS ABS QNT,1000704,CDM,300,RC,,,outpatient,,,52.25,26.13,,50.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.15,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,47.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,35.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,48.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,49.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,50.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.87,102.86,
"VITAMIN D1, 25 DIHYDROXY",1000705,CDM,300,RC,,,outpatient,,,69.75,34.88,,67.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,62.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,56.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,51.98,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,64.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,67.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,38.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.5,102.86,
VITAMIN C,1000706,CDM,300,RC,,,outpatient,,,73,36.5,,70.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,65.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,53.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,49.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,58.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,48.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.35,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,67.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,69.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,70.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,65.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.89,102.86,
VITAMIN E,1000707,CDM,300,RC,,,outpatient,,,47.75,23.88,,46.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.29,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,42.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.14,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,43.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,45.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,46.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.18,102.86,
VITAMIN B6,1000708,CDM,300,RC,,,outpatient,,,86,43,,83.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.35,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,77.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,69.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,57.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,37.94,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,79.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,77.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,28.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.1,102.86,
VITAMIN B1,1000709,CDM,300,RC,,,outpatient,,,61.5,30.75,,59.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,55.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,44.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,41.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,40.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.66,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,56.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,58.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,59.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,55.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,21.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.23,102.86,
VITAMIN A,1000710,CDM,300,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.67,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.61,102.86,
TEGRETOL,1000711,CDM,300,RC,,,outpatient,,,46.25,23.13,,44.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,41.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.67,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,42.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.57,102.86,
LAMICTAL,1000712,CDM,300,RC,,,outpatient,,,672.75,336.38,,652.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,605.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,605.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,489.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,459.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,543.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,543.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,596.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,446.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.89,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,618.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,639.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,652.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,437.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,605.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.25,605.48,
"TOPIRAMATE, SERUM",1000713,CDM,300,RC,,,outpatient,,,114.25,57.13,,110.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,102.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,102.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,83.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,92.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,75.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.09,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,105.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,108.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,110.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.92,102.86,
ETHOSUXIMIDE,1000714,CDM,300,RC,,,outpatient,,,58,29,,56.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.34,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.16,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,52.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.34,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.34,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.06,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,53.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,55.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,56.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.34,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.34,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.34,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,52.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.34,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.34,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.34,102.86,
OXCARBAZEPINE,1000715,CDM,300,RC,,,outpatient,,,35,17.5,,33.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,31.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.89,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,32.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.25,102.86,
KEPPRA,1000716,CDM,300,RC,,,outpatient,,,69.75,34.88,,67.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,62.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,56.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.89,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,64.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,67.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.25,102.86,
LACOSAMIDE,1000717,CDM,300,RC,,,outpatient,,,381,190.5,,369.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,114.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,342.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,342.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,277.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,260.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,307.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,307.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,337.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,252.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.6,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,350.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,361.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,369.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,247.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,342.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,27.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.11,342.9,
ERYTHROPOIETIN,1000718,CDM,300,RC,,,outpatient,,,19.5,9.75,,18.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.29,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,17.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.55,102.86,
ENVIL,1000719,CDM,300,RC,,,outpatient,,,69.75,34.88,,67.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,62.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,41.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,56.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,64.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,67.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,41.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,41.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.85,102.86,
"NICOTINE/METABOLITES QNT, PLASMA/SERUM",1000720,CDM,300,RC,,,outpatient,,,107.75,53.88,,104.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,95.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,71.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,87.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,99.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,102.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,104.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"BENZODIAZEPINE & METABOLITE CONFIRM, U",1000721,CDM,300,RC,,,outpatient,,,274.75,137.38,,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.28,
OPIATE CONFIRMATION URINE (4 DRUGS),1000722,CDM,300,RC,,,outpatient,,,82,41,,79.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,73.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,55.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,77.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,79.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,49.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.2,102.86,
AMPHETAMINE CONFIRM URINE,1000723,CDM,300,RC,,,outpatient,,,46.25,23.13,,44.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,41.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,37.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,42.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,27.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.75,102.86,
BUPRENORPHINE CONF URINE,1000724,CDM,300,RC,,,outpatient,,,424.25,212.13,,411.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,254.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,381.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,381.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,289.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,254.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,342.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,375.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,281.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,343.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,390.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,403.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,411.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,275.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,254.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,254.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,381.83,
METHADONE CONFIRMATION URINE,1000725,CDM,300,RC,,,outpatient,,,82,41,,79.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,73.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,55.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,77.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,79.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,49.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.2,102.86,
CANBINOID CONFIRM URINE,1000726,CDM,300,RC,,,outpatient,,,82,41,,79.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,73.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,55.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,77.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,79.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,49.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.2,102.86,
"OXYCODONE CONFIRMATION, URINE",1000727,CDM,300,RC,,,outpatient,,,248.75,124.38,,241.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,149.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,223.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,223.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,169.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,149.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,220.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,164.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,201.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,228.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,236.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,241.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,161.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,149.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,149.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,223.88,
Testing for presence of drug,1000728,CDM,300,RC,,,outpatient,,,222.25,111.13,,215.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,200.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,161.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,151.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,179.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,179.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,196.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,147.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.89,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,204.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,211.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,215.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,144.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,200.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,200.03,
OXALATE  24HR URINE,1000729,CDM,300,RC,,,outpatient,,,39.5,19.75,,38.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.51,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,36.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,37.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,38.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.45,102.86,
CITRIC ACID 24H URINE,1000730,CDM,300,RC,,,outpatient,,,71.75,35.88,,69.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.09,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,52.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,57.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,37.53,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,66.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,68.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,27.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.8,102.86,
REL CALCULUS,1000732,CDM,300,RC,,,outpatient,,,53.25,26.63,,51.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.15,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,47.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,47.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,48.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.87,102.86,
URIC ACID 24HR URINE,1000733,CDM,300,RC,,,outpatient,,,15.5,7.75,,15.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.86,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,14.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.08,102.86,
PHOSPHORUS 24HR URINE,1000734,CDM,300,RC,,,outpatient,,,15.5,7.75,,15.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.8,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,14.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.78,102.86,
MAGNESIUM 24HR URINE,1000735,CDM,300,RC,,,outpatient,,,21.5,10.75,,20.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.8,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.05,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,19.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.7,102.86,
METANEPHRINES FRACT 24HR URINE,1000736,CDM,300,RC,,,outpatient,,,86,43,,83.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.68,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,77.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,69.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,57.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.87,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,79.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,77.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.94,102.86,
Test to determine levels of immunoglobulins in the blood,1000738,CDM,300,RC,,,outpatient,,,14.5,7.25,,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.56,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,13.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,102.86,
IMMUNOGLOBULIN E TOTAL,1000739,CDM,300,RC,,,outpatient,,,24.75,12.38,,24.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.22,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,22.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.46,102.86,
Test to determine levels of immunoglobulins in the blood,1000740,CDM,300,RC,,,outpatient,,,14.5,7.25,,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.56,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,13.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,102.86,
Test to determine levels of immunoglobulins in the blood,1000741,CDM,300,RC,,,outpatient,,,17.5,8.75,,16.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,15.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.56,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,16.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,102.86,
INSULIN,1000742,CDM,300,RC,,,outpatient,,,14.25,7.13,,13.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.43,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,13.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.43,102.86,
COMPLEMENT C3,1000743,CDM,300,RC,,,outpatient,,,16,8,,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.2,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,14.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12,102.86,
COMPLEMENT C4,1000744,CDM,300,RC,,,outpatient,,,14.5,7.25,,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.2,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,13.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12,102.86,
"COMPLEMENT TOTAL, CH50",1000745,CDM,300,RC,,,outpatient,,,16,8,,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.43,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,14.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,20.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.4,102.86,
LDL DIRECT,1000746,CDM,300,RC,,,outpatient,,,29,14.5,,28.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.18,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,26.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,10.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.5,102.86,
OSMOLALITY URINE,1000747,CDM,300,RC,,,outpatient,,,19.5,9.75,,18.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.9,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.21,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,17.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.82,102.86,
OSMOLALITY SERUM,1000748,CDM,300,RC,,,outpatient,,,16,8,,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.92,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,14.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.61,102.86,
A - LC 164947,1000749,CDM,300,RC,,,outpatient,,,15.25,7.63,,14.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.48,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,13.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.32,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,14.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.09,102.86,
Chemical test of the blood to measure presence or concentration of a substance in the blood,1000750,CDM,300,RC,,,outpatient,,,57.5,28.75,,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,52.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,54.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,102.86,
Chemical test of the blood to measure presence or concentration of a substance in the blood,1000751,CDM,300,RC,,,outpatient,,,49.5,24.75,,48.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,44.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,33.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,39.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,32.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,45.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,47.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,48.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,44.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,102.86,
ANTI D (DS) ABS,1000754,CDM,300,RC,,,outpatient,,,19.5,9.75,,18.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.55,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,17.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.74,102.86,
Blood test to diagnose rheumatoid arthritis,1000755,CDM,300,RC,,,outpatient,,,62,31,,60.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,45.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,42.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.48,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,57.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,58.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,60.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.95,102.86,
Chemical test of the blood to measure presence or concentration of a substance in the blood,1000756,CDM,300,RC,,,outpatient,,,19.5,9.75,,18.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,17.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,102.86,
CALCIUM IONIZED,1000757,CDM,300,RC,,,outpatient,,,14.25,7.13,,13.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.86,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.47,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,13.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.83,102.86,
TRANSFERRIN,1000758,CDM,300,RC,,,outpatient,,,16,8,,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.76,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.76,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.76,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.23,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,14.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.76,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.76,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.76,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.76,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.76,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.76,102.86,
AFP TUMOR MARKER,1000760,CDM,300,RC,,,outpatient,,,16,8,,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.64,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,14.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.4,102.86,
INHIBIN B,1000762,CDM,300,RC,,,outpatient,,,382.5,191.25,,371.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,344.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,344.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,278.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,261.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,308.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,308.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,338.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,253.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.31,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,351.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,363.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,371.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,248.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,344.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,344.25,
Blood test to monitor for cancer in the ovaries or testis,1000763,CDM,300,RC,,,outpatient,,,474.75,237.38,,460.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,427.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,427.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,345.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,324.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,383.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,383.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,420.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,314.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.05,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,436.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,451.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,460.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,308.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,427.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.59,427.28,
FACTOR V LEIDEN MUTATION ALYSIS,1000764,CDM,310,RC,,,outpatient,,,243.75,121.88,,236.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,57.23,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,219.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,219.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,177.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,166.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,196.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,196.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,215.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,161.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,,,,,Other,Not Separately reimbursable,224.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,231.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,236.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,158.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,73.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,73.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,219.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,73.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,73.37,219.38,
ANTITHROMBIN ACTIVITY,1000765,CDM,300,RC,,,outpatient,,,77,38.5,,74.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,56.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,51.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,70.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,73.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.85,102.86,
PROTEIN S FUNCTIOL,1000766,CDM,300,RC,,,outpatient,,,130.25,65.13,,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.28,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,94.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,88.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.68,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,119.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,123.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.32,117.23,
PROTEIN C FUNCTIOL (ACTIVITY),1000767,CDM,300,RC,,,outpatient,,,103,51.5,,99.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,92.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,74.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,70.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,83.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,68.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.68,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,94.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,97.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,99.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,92.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.84,102.86,
PROTEIN C ANTIGEN,1000768,CDM,300,RC,,,outpatient,,,134.5,67.25,,130.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,121.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,97.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,108.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.21,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,123.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,127.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,130.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,121.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.01,121.05,
FACTOR II (PROTIME) D ALYSIS,1000769,CDM,310,RC,,,outpatient,,,369.25,184.63,,358.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.69,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,332.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,332.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.69,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,268.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,252.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,65.69,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,298.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,298.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,327.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,244.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,,,,,Other,Not Separately reimbursable,339.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,350.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,358.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,240.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,65.69,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,65.69,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,65.69,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,332.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.69,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,65.69,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,65.69,332.33,
ACE,1000771,CDM,300,RC,,,outpatient,,,16,8,,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.65,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.71,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,14.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.4,102.86,
C-PEPTIDE SERUM,1000772,CDM,300,RC,,,outpatient,,,19.5,9.75,,18.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.04,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.09,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,17.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.55,102.86,
ALDOLASE,1000773,CDM,300,RC,,,outpatient,,,12,6,,11.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.11,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,11.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.71,102.86,
ACTH,1000774,CDM,300,RC,,,outpatient,,,91.5,45.75,,88.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,82.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,66.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,62.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,73.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,60.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,52.14,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,84.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,86.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,88.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,82.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,38.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.62,102.86,
SICKLE CELL SCREEN,1000775,CDM,300,RC,,,outpatient,,,17.25,8.63,,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.77,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.44,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,15.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.51,102.86,
LEGIONELLA AG URINE RANDOM,1000776,CDM,300,RC,,,outpatient,,,89.5,44.75,,86.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,80.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,65.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,72.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.17,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,82.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,85.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,86.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,80.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.98,102.86,
ALPHA 1-ANTITRYPSIN,1000777,CDM,300,RC,,,outpatient,,,16,8,,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.65,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.14,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,14.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.44,102.86,
FAT FECAL QNT,1000778,CDM,300,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.68,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.8,102.86,
IGF 1,1000779,CDM,300,RC,,,outpatient,,,50.25,25.13,,48.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,45.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.7,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,46.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,47.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,48.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,45.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,21.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.26,102.86,
MANNOSE BINDING LECTIN,1000780,CDM,300,RC,,,outpatient,,,143.25,71.63,,138.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,128.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,104.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,97.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,115.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,94.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.31,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,131.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,136.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,138.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,128.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,128.93,
STREP PNEUMO 7 SEROTYPES,1000781,CDM,300,RC,,,outpatient,,,452.25,226.13,,438.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,407.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,407.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,329.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,308.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,365.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,365.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,400.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,299.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.24,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,416.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,429.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,438.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,293.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,407.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.99,407.03,
CD4-CD8 RATIO PROFILE,1000782,CDM,300,RC,,,outpatient,,,182.75,91.38,,177.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,132.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,124.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,46.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,147.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,161.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,63.42,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,168.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,173.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,177.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,46.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,46.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.98,164.48,
5-HIAA QNT 24H URINE,1000783,CDM,300,RC,,,outpatient,,,19.5,9.75,,18.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.18,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.42,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,17.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.9,102.86,
Chemical test of the blood to measure presence or concentration of a substance in the blood,1000784,CDM,300,RC,,,outpatient,,,102.75,51.38,,99.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,92.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,74.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,70.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,82.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,68.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,94.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,97.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,99.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,92.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,102.86,
QUANTIFERON-TB GOLD,1000785,CDM,300,RC,,,outpatient,,,210.5,105.25,,204.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,53.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,189.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,189.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,153.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,143.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,61.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,169.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,169.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,186.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,139.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.67,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,193.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,199.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,204.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,136.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,61.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,61.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,61.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,189.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,61.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,61.98,189.45,
TRYPTASE,1000786,CDM,300,RC,,,outpatient,,,538.25,269.13,,522.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,484.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,484.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,391.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,367.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,434.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,434.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,476.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,356.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.31,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,495.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,511.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,522.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,349.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,484.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,484.43,
STREP PNEUMO ANTIGEN URINE/CSF,1000787,CDM,300,RC,,,outpatient,,,123,61.5,,119.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,110.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,89.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,99.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.69,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,113.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,119.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,110.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.07,110.7,
ALTERRIA ALTERTA,1000788,CDM,300,RC,,,outpatient,,,16,8,,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.52,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.05,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,14.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,102.86,
ASPERGILLUS FUMIGATUS,1000789,CDM,300,RC,,,outpatient,,,16,8,,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.52,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.05,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,14.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,102.86,
LATEX ALLERGEN,1000790,CDM,300,RC,,,outpatient,,,16,8,,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.52,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.05,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,14.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,102.86,
ENDOMYSIAL AB IGA,1000791,CDM,300,RC,,,outpatient,,,49.5,24.75,,48.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,44.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,33.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,39.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,32.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.27,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,45.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,47.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,48.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,44.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,102.86,
GLUTAMIC ACID DECARBOXYLASE (GAD65) ABS,1000792,CDM,300,RC,,,outpatient,,,115.25,57.63,,111.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.35,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,83.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,93.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.84,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,106.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.4,103.73,
GASTRIN,1000793,CDM,300,RC,,,outpatient,,,36.25,18.13,,35.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.28,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,32.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.8,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,33.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.63,102.86,
HEMOCHROMATOSIS D ALYSIS,1000794,CDM,310,RC,,,outpatient,,,371.25,185.63,,360.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.36,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,56.64,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,334.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,334.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.36,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,270.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,253.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,65.36,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,299.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,299.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,328.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,246.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,,,,,Other,Not Separately reimbursable,341.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,352.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,360.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,241.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,65.36,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,65.36,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,65.36,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,334.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.36,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,65.36,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,65.36,334.13,
MAGNESIUM RBC,1000795,CDM,300,RC,,,outpatient,,,144.75,72.38,,140.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.8,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,105.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,116.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.05,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,133.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,130.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.7,130.28,
"METHYLMALONIC ACID, SERUM",1000796,CDM,300,RC,,,outpatient,,,77,38.5,,74.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.21,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.21,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,56.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.21,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,51.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.63,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,70.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,73.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.21,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.21,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.21,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.21,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,21.21,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.21,102.86,
SEROTONIN SERUM,1000797,CDM,300,RC,,,outpatient,,,69.75,34.88,,67.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.86,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,62.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,56.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,41.82,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,64.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,67.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,30.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,30.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.98,102.86,
PROCALCITONIN,1000798,CDM,300,RC,,,outpatient,,,285.5,142.75,,276.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,256.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,256.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,207.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,194.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,230.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,230.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,252.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,189.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.75,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,262.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,271.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,276.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,185.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,256.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,27.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.22,256.95,
ANTI MULLERIAN HORMONE (AMH),1000799,CDM,300,RC,,,outpatient,,,265.25,132.63,,257.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,238.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,238.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,193,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,181.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,214.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,214.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,235.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,175.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.06,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,244.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,251.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,257.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,172.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,238.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.12,238.73,
HISTAMINE DETERMITION PLASMA,1000800,CDM,300,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,29.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,39.87,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,29.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,29.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.5,102.86,
JAK2 MUTATION ALYSIS QUAL,1000801,CDM,310,RC,,,outpatient,,,182.75,91.38,,177.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.66,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,79.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.66,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,132.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,124.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,91.66,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,147.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,161.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,,,,,Other,Not Separately reimbursable,168.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,173.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,177.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,91.66,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,91.66,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,91.66,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.66,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,91.66,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90,164.48,
MYOGLOBIN SERUM,1000802,CDM,300,RC,,,outpatient,,,38.25,19.13,,37.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.19,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.44,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,35.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,36.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.92,102.86,
MYOGLOBIN URINE QNT,1000803,CDM,300,RC,,,outpatient,,,48.5,24.25,,47.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.19,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,43.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,33.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,39.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,32.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.44,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,44.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,46.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,47.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,43.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.92,102.86,
"ALDOSTERONE, SERUM LC/MS",1000804,CDM,300,RC,,,outpatient,,,61.5,30.75,,59.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.32,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,55.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,44.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,41.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,40.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,40.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,55.01,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,56.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,58.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,59.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,40.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,55.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,40.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.75,102.86,
ANDROSTENEDIONE,1000805,CDM,300,RC,,,outpatient,,,76.75,38.38,,74.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,69.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,55.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,29.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,61.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,39.53,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,70.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,29.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,69.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,29.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.28,102.86,
ANTI SCL70,1000806,CDM,300,RC,,,outpatient,,,24,12,,23.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.55,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.21,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,22.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,102.86,
ASO ABS,1000808,CDM,300,RC,,,outpatient,,,136.75,68.38,,132.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,99.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,110.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,90.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.86,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,125.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,129.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,132.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,123.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,7.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.3,123.08,
BETA-HYDROXYBUTYRATE,1000810,CDM,300,RC,,,outpatient,,,98.75,49.38,,95.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.08,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,88.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,71.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,79.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.03,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,90.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,93.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,95.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,88.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.17,102.86,
Blood test to monitor breast cancer,1000811,CDM,300,RC,,,outpatient,,,27.25,13.63,,26.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.04,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.09,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,25.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.81,102.86,
CA 19-9,1000812,CDM,300,RC,,,outpatient,,,29,14.5,,28.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.04,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.09,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,26.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.81,102.86,
"CALPROTECTIN, FECAL",1000813,CDM,300,RC,,,outpatient,,,489.25,244.63,,474.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,440.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,440.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,355.98,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,333.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,394.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,394.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,433.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,324.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.5,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,450.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,464.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,474.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,318.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,440.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,19.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.63,440.33,
CERULOPLASMIN,1000814,CDM,300,RC,,,outpatient,,,23,11.5,,22.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,20.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.5,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,21.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.74,102.86,
COLD AGGLUTININ TITER,1000815,CDM,300,RC,,,outpatient,,,37.75,18.88,,36.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,33.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.88,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,34.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,36.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.06,102.86,
CRYSTALS BODY FLUID,1000816,CDM,300,RC,,,outpatient,,,35.75,17.88,,34.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.2,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.9,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,32.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,7.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.33,102.86,
HEPARIN INDUCED PLT ANTIBODY,1000817,CDM,300,RC,,,outpatient,,,172.5,86.25,,167.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,155.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,125.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,117.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,139.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.8,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,158.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,163.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,167.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,155.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.37,155.25,
GROWTH HORMONE,1000818,CDM,300,RC,,,outpatient,,,34,17,,32.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.45,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.5,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,31.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,32.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.67,102.86,
HAPTOGLOBIN,1000819,CDM,300,RC,,,outpatient,,,19.5,9.75,,18.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.9,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.98,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,17.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.58,102.86,
LIPOPROTEIN A,1000820,CDM,300,RC,,,outpatient,,,41.75,20.88,,40.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.33,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,38.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,39.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.32,102.86,
MANGANESE PLASMA,1000821,CDM,300,RC,,,outpatient,,,127,63.5,,123.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.32,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,114.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,92.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,86.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,84.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.98,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,116.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,120.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,123.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,114.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,26.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.65,114.3,
"MYELIN BASIC PROTEIN, CSF",1000822,CDM,300,RC,,,outpatient,,,55.5,27.75,,53.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,49.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,44.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.22,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,51.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,52.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,53.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.2,102.86,
VITAMIN B3,1000823,CDM,300,RC,,,outpatient,,,668.5,334.25,,648.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,601.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,601.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,486.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,456.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,539.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,592.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,443.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.03,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,615.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,635.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,648.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,601.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.06,601.65,
5' NUCLEOTIDASE,1000824,CDM,300,RC,,,outpatient,,,25.75,12.88,,24.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.15,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.66,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,23.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.15,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.15,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.05,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,23.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.15,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.15,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.15,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.15,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.15,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.15,102.86,
PLATELET ANTIBODY PROFILE,1000825,CDM,300,RC,,,outpatient,,,134,67,,129.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,120.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,97.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,108.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,88.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.8,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,123.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,127.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,129.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,120.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.37,120.6,
SIROLIMUS BLOOD,1000826,CDM,300,RC,,,outpatient,,,86,43,,83.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.9,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,77.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,69.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,57.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.54,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,79.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,77.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.73,102.86,
RENIN PLASMA,1000827,CDM,300,RC,,,outpatient,,,50.25,25.13,,48.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,45.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.69,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,46.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,47.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,48.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,45.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,21.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.99,102.86,
"SELENIUM, SERUM/PLASMA",1000828,CDM,300,RC,,,outpatient,,,120.25,60.13,,116.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.13,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,108.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,87.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,97.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.47,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,110.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,108.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,25.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.53,108.23,
THYROTROPIN RECEPTOR AB,1000829,CDM,300,RC,,,outpatient,,,65.25,32.63,,63.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,52.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.31,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,60.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,58.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,102.86,
SERUM PROTEIN ELECTROPHORESIS,1000835,CDM,300,RC,,,outpatient,,,16.5,8.25,,16.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.5,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,15.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.74,102.86,
.O&P SMEAR (1000836),1000836,CDM,300,RC,,,outpatient,,,39.75,19.88,,38.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.71,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,35.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.02,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,36.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,37.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,38.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.9,102.86,
.O&P STAIN (1000836),1000837,CDM,300,RC,,,outpatient,,,39.75,19.88,,38.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.58,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,35.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.27,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,36.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,37.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,38.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.98,102.86,
HEP C GENOTYPE,1000840,CDM,300,RC,,,outpatient,,,1298.5,649.25,,1259.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,257.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,223.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1168.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,1168.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,257.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,944.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,886.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,257.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,1048.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1048.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1150.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,860.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,347.56,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,1194.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,1233.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,1259.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,844.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,257.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,257.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,257.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,1168.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,257.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,257.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90,1168.65,
SALIVARY CORTISOL MS,1000861,CDM,300,RC,,,outpatient,,,180.25,90.13,,174.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.13,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,162.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,162.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,131.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,145.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,145.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,159.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,119.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.01,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,165.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,171.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,174.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,162.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.3,162.23,
Test for HIV,1000865,CDM,300,RC,,,outpatient,,,11.75,5.88,,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32.51,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,10.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,24.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.58,102.86,
"TOBRAMYCIN, TROUGH",1000866,CDM,300,RC,,,outpatient,,,29.25,14.63,,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.98,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.78,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,26.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.13,102.86,
LEAD & PROTOPORPHYRIN,1000890,CDM,300,RC,,,outpatient,,,86.25,43.13,,83.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,77.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,69.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,57.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,79.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,77.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.35,102.86,
PRIMIDONE & PHENOBARB,1000895,CDM,300,RC,,,outpatient,,,192.25,96.13,,186.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.38,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,173.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,173.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,139.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,131.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,155.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,170.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,127.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.4,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,176.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,182.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,186.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,173.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.59,173.03,
.CRYPTO (1000635),1000901,CDM,300,RC,,,outpatient,,,65,32.5,,63.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.78,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,52.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.66,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,59.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.82,102.86,
.GIARDIA (1000635),1000902,CDM,300,RC,,,outpatient,,,65,32.5,,63.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,52.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.17,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,59.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.98,102.86,
Testing for presence of drug,1000904,CDM,300,RC,,,outpatient,,,299.5,149.75,,290.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,269.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,269.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,217.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,204.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,241.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,241.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,265.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,198.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.89,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,275.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,284.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,290.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,194.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,269.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,269.55,
Testing for presence of drug,1000905,CDM,300,RC,,,outpatient,,,329,164.5,,319.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,296.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,296.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,239.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,224.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,265.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,265.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,291.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,218.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.89,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,302.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,312.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,319.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,296.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,296.1,
.ANCA - 1000920 & 1000930,1000921,CDM,300,RC,,,outpatient,,,26.25,13.13,,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.27,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,24.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,102.86,
.CANCA/PANCA - 1000920,1000922,CDM,300,RC,,,outpatient,,,52.5,26.25,,50.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,35.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.27,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,48.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,49.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,50.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,102.86,
.MPO ABS - 1000920,1000923,CDM,300,RC,,,outpatient,,,26.25,13.13,,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.31,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,24.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,102.86,
.PR3 ABS - 1000920,1000924,CDM,300,RC,,,outpatient,,,26.25,13.13,,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.31,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,24.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,102.86,
.MPO ABS - 1000925,1000926,CDM,300,RC,,,outpatient,,,26.25,13.13,,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.27,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,24.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,102.86,
.PR3 ABS - 1000925,1000927,CDM,300,RC,,,outpatient,,,26.25,13.13,,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.31,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,24.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,102.86,
"CYSTINE QNT, 24H URINE",1000931,CDM,300,RC,,,outpatient,,,115.25,57.63,,111.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,83.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,93.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,31.02,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,106.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,22.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.98,103.73,
Test to determine levels of immunoglobulins in the blood,1000936,CDM,300,RC,,,outpatient,,,36,18,,34.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,32.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.56,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,33.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,102.86,
Chemical test of the blood to measure presence or concentration of a substance in the blood,1000937,CDM,300,RC,,,outpatient,,,36,18,,34.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,32.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,33.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,102.86,
Chemical test of the blood to measure presence or concentration of a substance in the blood,1000938,CDM,300,RC,,,outpatient,,,107.75,53.88,,104.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,78.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,86.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,95.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,71.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,99.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,102.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,104.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,96.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,102.86,
.ENDOMYSIAL ABS - 1000935,1000939,CDM,300,RC,,,outpatient,,,36,18,,34.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,32.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.27,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,33.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,102.86,
VARICELLA ZOSTER IGG,1000962,CDM,300,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.16,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.39,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,102.86,
.17 OH PROGEST- 1000965 & 1000970,1000966,CDM,300,RC,,,outpatient,,,882,441,,855.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.55,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,793.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,793.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,641.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,601.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,711.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,711.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,781.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,584.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.68,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,811.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,837.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,855.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,573.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,793.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,27.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.17,793.8,
.SIALIC ACID- 1000980,1000981,CDM,300,RC,,,outpatient,,,417,208.5,,404.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.65,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,375.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,375.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,303.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,284.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,336.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,336.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,369.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,276.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.14,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,383.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,396.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,404.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,271.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,375.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.44,375.3,
FOLATE RBC,1000985,CDM,300,RC,,,outpatient,,,56.5,28.25,,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.02,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.83,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,51.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,53.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.65,102.86,
PSA (prostate specific antigen) measurement,1000990,CDM,300,RC,,,outpatient,,,241.75,120.88,,234.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.94,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,217.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,217.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,175.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,164.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,195.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,195.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,214.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,160.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.83,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,222.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,229.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,234.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,157.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,217.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.39,217.58,
Coagulation assessment blood test,1001004,CDM,300,RC,,,outpatient,,,60.75,30.38,,58.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.2,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,54.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,44.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,41.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,53.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,40.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.11,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,55.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,57.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,58.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,54.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.01,102.86,
WBC COUNT ONLY,1001007,CDM,300,RC,,,outpatient,,,26.5,13.25,,25.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.2,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,23.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.43,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,24.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,2.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.54,102.86,
"Complete blood count, automated",1001008,CDM,300,RC,,,outpatient,,,48.75,24.38,,47.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.6,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,43.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,33.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,39.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,32.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.73,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,44.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,46.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,47.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,43.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,102.86,
CELL COUNT FLUID W/DIFF,1001014,CDM,300,RC,,,outpatient,,,101,50.5,,97.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.77,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,90.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,73.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,68.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,81.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,66.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.56,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,92.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,95.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,97.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.6,102.86,
ERYTHROCYTE SED RATE,1001026,CDM,300,RC,,,outpatient,,,39.75,19.88,,38.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,35.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.76,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,36.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,37.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,38.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,102.86,
"Blood test, clotting time",1001032,CDM,300,RC,,,outpatient,,,42.5,21.25,,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.79,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,39.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.29,102.86,
FINE NEEDLE ASP,1001044,CDM,311,RC,,,outpatient,,,99.25,49.63,,96.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.69,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,89.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,80.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,91.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,94.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,96.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,102.86,
PATH 1 TECH,1001050,CDM,310,RC,,,outpatient,,,71.75,35.88,,69.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,58.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,66.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,68.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.05,102.86,
PATH II TECH,1001052,CDM,310,RC,,,outpatient,,,50,25,,48.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,30,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,45,90,,,percent of total billed charges,Pays at 90% of total billed charges,45,90,,,percent of total billed charges,Pays at 90% of total billed charges,30,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,40.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,46,92,,,percent of total billed charges,Pays at 92% of total billed charges,47.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,48.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,30,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45,90,,,percent of total billed charges,Pays at 90% of total billed charges,30,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,30,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30,102.86,
PATH III TECH,1001054,CDM,310,RC,,,outpatient,,,62,31,,60.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,42.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,50.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,57.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,58.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,60.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.2,102.86,
Test of tissues for diagnosis of abnormalities,1001056,CDM,310,RC,,,outpatient,,,202.75,101.38,,196.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,138.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,163.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,179.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,134.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,164.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,186.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,192.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,196.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,182.48,
PATH V TECH,1001058,CDM,310,RC,,,outpatient,,,254,127,,246.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,152.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,189.98,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,228.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,228.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,173.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,152.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,205.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,225.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,168.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,205.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,233.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,241.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,246.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,165.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,152.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,152.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,228.6,
PATH V Pro ALL INCLUSIVE BILLING ONLY,1001059,CDM,310,RC,,,outpatient,,,183.25,91.63,,177.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,189.98,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,164.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,125.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,148.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,168.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,174.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,177.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,119.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,164.93,
PATH LEVEL VI TECH,1001060,CDM,310,RC,,,outpatient,,,367,183.5,,355.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,220.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,290.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,330.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,330.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,220.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,267.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,250.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,220.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,296.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,296.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,325.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,243.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,297.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,337.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,348.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,355.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,238.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,220.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,220.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,220.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,330.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,220.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,220.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,330.3,
PATH LEVEL VI Pro ALL INCLUSIV BILL ONLY,1001061,CDM,310,RC,,,outpatient,,,636.75,318.38,,617.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,382.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,290.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,573.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,573.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,382.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,463.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,434.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,382.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,513.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,513.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,564.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,422.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,515.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,585.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,604.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,617.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,413.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,382.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,382.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,382.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,573.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,382.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,382.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,573.08,
Blood test to assist with diagnosis,1001078,CDM,310,RC,,,outpatient,,,145.5,72.75,,141.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,99.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,117.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,96.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,133.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,138.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,141.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.95,
Blood test to assist with diagnosis,1001082,CDM,310,RC,,,outpatient,,,88.75,44.38,,86.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.6,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,79.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,53.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,81.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,84.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,86.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,53.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,53.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.25,102.86,
Blood test to assist with diagnosis,1001083,CDM,310,RC,,,outpatient,,,121.75,60.88,,118.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.6,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,98.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,115.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,118.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,109.58,
Pathology test,1001088,CDM,310,RC,,,outpatient,,,147,73.5,,142.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,132.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,100.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,88.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,97.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,119.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,135.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,139.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,142.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,88.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,88.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,132.3,
LEUKEMIA/LYMPHOMA FLOW CYTOMETRY,1001100,CDM,311,RC,,,outpatient,,,161,80.5,,156.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,144.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,144.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,109.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,129.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,106.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,130.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,148.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,152.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,156.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,144.9,
"PROTEIN ELECTROPH, URINE RANDOM",1001200,CDM,300,RC,,,outpatient,,,118,59,,114.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.83,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.45,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,106.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.83,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,85.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,80.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.83,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,95.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,95.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,104.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,78.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.07,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,108.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,112.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,114.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.83,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.83,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.83,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,106.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.83,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.83,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.83,106.2,
"IMMUNOFIXATION, URINE, R OR 24H",1001208,CDM,300,RC,,,outpatient,,,67,33.5,,64.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,60.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,48.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,45.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,29.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,54.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,59.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,44.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,39.62,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,61.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,63.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,64.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,29.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,60.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,29.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.35,102.86,
THYROGLOBULIN AB,1001210,CDM,300,RC,,,outpatient,,,19.5,9.75,,18.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.78,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.48,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,17.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.91,102.86,
"MERCURY, PLASMA",1001214,CDM,300,RC,,,outpatient,,,131.5,65.75,,127.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.09,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,118.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,95.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,106.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.95,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,120.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,124.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,127.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,118.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.26,118.35,
"TESTOSTERONE, FREE DIRECT",1001221,CDM,300,RC,,,outpatient,,,182.75,91.38,,177.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,132.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,124.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,147.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,161.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.38,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,168.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,173.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,177.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.47,164.48,
"HOMOCYSTEINE, PLASMA",1001222,CDM,300,RC,,,outpatient,,,69.75,34.88,,67.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,62.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,56.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.19,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,64.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,67.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.92,102.86,
B12-FOLATE HEALTH FAIR,1001223,CDM,300,RC,,,outpatient,,,111.25,55.63,,107.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,100.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,66.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,75.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,66.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,73.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,105.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,107.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,66.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,66.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,66.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,100.13,
PAP smear,1001225,CDM,310,RC,,,outpatient,,,116.75,58.38,,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,84.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,,,,,Other,Not Separately reimbursable,107.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,20.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.26,105.08,
PAP smear,1001226,CDM,923,RC,,,outpatient,,,116.75,58.38,,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,84.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.35,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,107.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,20.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.26,105.08,
HEP C CONFIRMATION,1001227,CDM,300,RC,,,outpatient,,,201.5,100.75,,195.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,181.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,181.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,146.61,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,137.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,162.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,178.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,133.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,185.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,191.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,195.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,130.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,181.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,181.35,
"HEP C CHARGE ONLY (R QUAL, A)",1001228,CDM,300,RC,,,outpatient,,,201.5,100.75,,195.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,181.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,181.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,146.61,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,137.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,162.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,178.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,133.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,185.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,191.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,195.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,130.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,181.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,181.35,
FECAL FAT QUALITATIVE,1001229,CDM,300,RC,,,outpatient,,,19.5,9.75,,18.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.89,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,17.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.1,102.86,
HIV 1 R QUALITATIVE,1001232,CDM,300,RC,,,outpatient,,,19.5,9.75,,18.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,17.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.55,102.86,
Detection test for human papillomavirus (hpv),1001233,CDM,923,RC,,,outpatient,,,192.25,96.13,,186.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,173.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,173.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,139.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,131.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,155.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,170.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,127.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,176.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,182.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,186.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,173.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,173.03,
IODINE SERUM,1001234,CDM,300,RC,,,outpatient,,,228.5,114.25,,221.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,205.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,205.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,166.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,155.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,184.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,184.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,202.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,151.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32.55,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,210.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,217.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,221.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,148.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,205.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,24.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.11,205.65,
"17 OH PROGESTERONE, SERUM",1001235,CDM,300,RC,,,outpatient,,,68.25,34.13,,66.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.55,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,55.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,45.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.68,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,62.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,66.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,27.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.17,102.86,
COCAINE METABOLITE CONFIRMATION URINE,1001236,CDM,300,RC,,,outpatient,,,79.25,39.63,,76.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,71.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,72.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,76.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,47.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.55,102.86,
MODIFIED HODGE (CHG ONLY),1001238,CDM,300,RC,,,outpatient,,,315.25,157.63,,305.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,283.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,283.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,229.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,215.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,254.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,254.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,279.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,209.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.41,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,290.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,299.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,305.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,204.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,283.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.75,283.73,
FENTANYL CONFIRM (MEDWATCH),1001239,CDM,300,RC,,,outpatient,,,443,221.5,,429.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,265.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,398.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,398.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,265.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,302.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,265.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,357.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,357.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,392.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,293.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,358.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,407.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,420.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,429.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,287.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,265.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,265.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,265.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,398.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,265.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,265.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,398.7,
Test to measure arterial blood gases,1001240,CDM,300,RC,,,outpatient,,,286.25,143.13,,277.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,257.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,257.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,208.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,195.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,231.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,231.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,253.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,189.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.19,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,263.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,271.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,277.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,186.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,257.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,26.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.07,257.63,
ANTIMYELOPEROXIDASE (MPO) ANTIBODIES,1001242,CDM,300,RC,,,outpatient,,,30.5,15.25,,29.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,27.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.31,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,28.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,102.86,
HEPARIN ANTI-XA,1001243,CDM,300,RC,,,outpatient,,,118.75,59.38,,115.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.35,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,106.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,86.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,81.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,95.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,95.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,78.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.67,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,109.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,112.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,115.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,106.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.09,106.88,
"CLOZAPINE, SERUM OR PLASMA",1001244,CDM,300,RC,,,outpatient,,,38.25,19.13,,37.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.15,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.15,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.15,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.2,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,35.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,36.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.15,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.15,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.15,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.15,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,20.15,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.15,102.86,
"EPSTEIN-BARR VIRUS, QUANT, PCR",1001245,CDM,306,RC,,,outpatient,,,502.75,251.38,,487.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.13,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,452.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,452.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,365.8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,343.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,405.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,405.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,445.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,333.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,57.83,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,462.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,477.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,487.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,326.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,452.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.84,452.48,
Testing for presence of drug,1001246,CDM,300,RC,,,outpatient,,,445.5,222.75,,432.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,400.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,324.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,304.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,359.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,359.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,394.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,295.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.89,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,409.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,423.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,432.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,289.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,400.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,400.95,
INSULIN AUTOANTIBODIES (IAA),1001247,CDM,302,RC,,,outpatient,,,51.75,25.88,,50.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,46.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,35.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.9,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,47.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,49.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,50.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,21.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.41,102.86,
.LDH - 1001250,1001251,CDM,300,RC,,,outpatient,,,192.25,96.13,,186.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.23,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,173.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,173.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,139.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,131.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,155.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,170.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,127.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.15,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,176.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,182.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,186.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,173.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.04,173.03,
.LDH ISOENZYMES - 1001250,1001252,CDM,300,RC,,,outpatient,,,192.25,96.13,,186.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.09,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,173.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,173.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,139.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,131.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,155.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,170.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,127.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.27,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,176.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,182.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,186.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,173.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.79,173.03,
.HPP (1001300),1001301,CDM,300,RC,,,outpatient,,,116.75,58.38,,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.58,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,84.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.27,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,107.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.98,105.08,
"Blood test, clotting time",1001302,CDM,300,RC,,,outpatient,,,116.75,58.38,,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,84.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.79,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,107.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.29,105.08,
.DRVVT CONFIRM SECONDS (1001300),1001303,CDM,300,RC,,,outpatient,,,116.75,58.38,,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.3,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,84.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.93,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,107.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.58,105.08,
.DRVVT SCREEN SECONDS (1001300),1001304,CDM,300,RC,,,outpatient,,,116.75,58.38,,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.3,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,84.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.93,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,107.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.58,105.08,
Coagulation assessment blood test,1001305,CDM,300,RC,,,outpatient,,,183.5,91.75,,178,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.2,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,165.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,133.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,125.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,148.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.11,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,168.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,174.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,178,97,,,percent of total billed charges,Pays at 97% of total billed charges,119.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,165.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.01,165.15,
.THROMBIN TIME (1001300),1001306,CDM,300,RC,,,outpatient,,,116.75,58.38,,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,84.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.79,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,107.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.77,105.08,
.APTT 1:1 NP (1001300),1001307,CDM,300,RC,,,outpatient,,,116.75,58.38,,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.6,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,84.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.73,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,107.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,105.08,
.APTT 1:1 SALINE (1001300),1001308,CDM,300,RC,,,outpatient,,,116.75,58.38,,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.6,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,84.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.73,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,107.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,105.08,
"B2-GLYCOPROTEIN ABS, IGA (1001300)",1001309,CDM,300,RC,,,outpatient,,,116.75,58.38,,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,84.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.36,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,107.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,105.08,
"B2-GLYCOPROTEIN ABS, IGG/IGM(1001300)",1001310,CDM,300,RC,,,outpatient,,,233,116.5,,226.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,209.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,169.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,188.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.36,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,214.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,221.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,209.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,209.7,
Blood test to determine cause of ippropriate blood clot formation,1001311,CDM,300,RC,,,outpatient,,,116.75,58.38,,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,84.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.36,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,107.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,105.08,
Blood test to determine cause of ippropriate blood clot formation,1001312,CDM,300,RC,,,outpatient,,,116.75,58.38,,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,84.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.36,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,107.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,105.08,
PHENOBARBITAL,1001320,CDM,300,RC,,,outpatient,,,14.75,7.38,,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.66,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,13.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.28,102.86,
PNEUMOCOCCAL 23 SEROTYPES,1001325,CDM,302,RC,,,outpatient,,,14.75,7.38,,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.24,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,13.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.28,102.86,
.PNEUMO SEROTYPES (1001325),1001326,CDM,302,RC,,,outpatient,,,314.25,157.13,,304.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,282.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,282.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,228.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,214.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,253.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,253.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,278.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,208.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.24,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,289.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,298.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,304.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,204.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,282.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.99,282.83,
Test that detects Chlamydia,1001327,CDM,300,RC,,,outpatient,,,378.75,189.38,,367.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,340.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,340.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,275.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,258.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,305.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,305.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,335.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,251.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,348.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,359.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,367.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,246.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,340.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,340.88,
Test that detects Chlamydia,1001328,CDM,300,RC,,,outpatient,,,378.75,189.38,,367.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,340.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,340.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,275.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,258.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,305.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,305.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,335.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,251.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,348.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,359.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,367.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,246.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,340.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,340.88,
IA2 AUTOANTIBODIES,1001501,CDM,300,RC,,,outpatient,,,161.25,80.63,,156.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.38,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,145.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,145.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,117.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,23.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,130.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,106.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,31.82,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,148.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,153.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,156.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,23.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,145.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,23.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.57,145.13,
.INSULIN (1001502),1001503,CDM,300,RC,,,outpatient,,,11,5.5,,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.43,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,10.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.9,102.86,
.C-PEPTIDE (1001502),1001504,CDM,300,RC,,,outpatient,,,11,5.5,,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.04,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.09,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,10.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.9,102.86,
"ARIPIPRAZOLE, SERUM",1001505,CDM,300,RC,,,outpatient,,,220.25,110.13,,213.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,198.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,150.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,177.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,195.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,146.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,178.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,202.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,209.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,213.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,143.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,198.23,
"DULOXETINE, SERUM",1001506,CDM,300,RC,,,outpatient,,,211.5,105.75,,205.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,126.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,190.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,190.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,126.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,153.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,144.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,126.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,170.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,187.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,140.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,171.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,194.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,200.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,205.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,137.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,126.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,126.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,126.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,190.35,
HSV CULTURE & TYPING,1001507,CDM,300,RC,,,outpatient,,,47.75,23.88,,46.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,42.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,45.71,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,43.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,45.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,46.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,33.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.86,102.86,
ANTIPROTEISE 3 ABS,1001508,CDM,300,RC,,,outpatient,,,30.5,15.25,,29.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,27.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.31,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,28.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,102.86,
MUMPS IGM ANTIBODIES,1001509,CDM,300,RC,,,outpatient,,,21.5,10.75,,20.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.62,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,19.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.05,102.86,
THIOPURINE METHYLTRANSFERASE,1001511,CDM,300,RC,,,outpatient,,,497,248.5,,482.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.79,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,447.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,447.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,361.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,339.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,401.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,401.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,440.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,329.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32.52,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,457.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,472.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,482.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,323.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,447.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,24.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.09,447.3,
"STREP PNEUMO AG, URINE/CSF",1001512,CDM,300,RC,,,outpatient,,,355.25,177.63,,344.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,319.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,319.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,258.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,242.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,286.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,286.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,314.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,235.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.69,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,326.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,337.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,344.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,230.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,319.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.07,319.73,
.MYCOPLASMA PNEUMO IGG (1001513),1001514,CDM,300,RC,,,outpatient,,,15.75,7.88,,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.87,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,14.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.24,102.86,
.MYCOPLASMA PNEUMO IGM (1001513),1001515,CDM,300,RC,,,outpatient,,,15.75,7.88,,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.87,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,14.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.24,102.86,
.TESTOSTERONE FREE (1001516),1001517,CDM,300,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.38,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.47,102.86,
.TESTOSTERONE TOTAL (1001516),1001518,CDM,300,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.84,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.81,102.86,
"HEMOGLOBIN, FREE, PLASMA",1001519,CDM,300,RC,,,outpatient,,,28.75,14.38,,27.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.87,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,26.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,7.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.31,102.86,
T3 UPTAKE,1001520,CDM,300,RC,,,outpatient,,,8,4,,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.6,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.73,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,7.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,102.86,
"EVEROLIMUS, WHOLE BLD",1001521,CDM,300,RC,,,outpatient,,,108.5,54.25,,105.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.9,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,97.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,78.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,74.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,87.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,71.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.54,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,99.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,103.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,105.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,97.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.73,102.86,
Test to determine levels of immunoglobulins in the blood,1001523,CDM,300,RC,,,outpatient,,,186.5,93.25,,180.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,167.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,167.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,135.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,127.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,150.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,165.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,123.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.56,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,171.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,177.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,180.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,167.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,167.85,
Chemical test of the blood to measure presence or concentration of a substance in the blood,1001524,CDM,300,RC,,,outpatient,,,186.5,93.25,,180.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,167.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,167.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,135.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,127.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,150.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,165.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,123.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,171.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,177.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,180.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,167.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,167.85,
Blood test to monitor breast cancer,1001525,CDM,300,RC,,,outpatient,,,17,8.5,,16.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.04,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.09,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,15.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.3,102.86,
"LACTOFERRIN, FECAL, QNT",1001526,CDM,300,RC,,,outpatient,,,314.25,157.13,,304.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,282.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,282.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,228.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,214.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,253.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,253.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,278.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,208.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.5,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,289.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,298.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,304.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,204.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,282.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,19.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.63,282.83,
.TESTOSTERONE FREE (1001527),1001528,CDM,300,RC,,,outpatient,,,117.5,58.75,,113.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,105.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,85.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,80.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,94.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,104.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.38,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,108.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,111.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,105.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.47,105.75,
.TESTOSTERONE TOTAL (1001527),1001529,CDM,300,RC,,,outpatient,,,117.5,58.75,,113.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,105.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,85.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,80.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,94.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,104.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.84,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,108.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,111.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,105.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.81,105.75,
Testing for presence of drug,1001530,CDM,300,RC,,,outpatient,,,57,28.5,,55.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,51.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.89,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,52.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,54.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,55.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.3,102.86,
A REFLEX - LC 164962,1001531,CDM,300,RC,,,outpatient,,,10,5,,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.48,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.32,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,9.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9,102.86,
A REFLEX - LC 164863,1001532,CDM,300,RC,,,outpatient,,,9.25,4.63,,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.48,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.32,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,8.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.33,102.86,
"A, QUALITATIVE - LC 164855",1001533,CDM,300,RC,,,outpatient,,,9.25,4.63,,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.48,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.32,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,8.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.33,102.86,
"PH, STOOL (UML-NON INTERF)",1001534,CDM,300,RC,,,outpatient,,,99,49.5,,96.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.1,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,72.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,79.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.83,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,91.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,94.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,96.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.58,102.86,
.ANTICHROMATIN ABS (CHG ONLY),1001535,CDM,300,RC,,,outpatient,,,73.75,36.88,,71.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.55,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,66.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,66.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,53.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,50.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,59.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,59.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,48.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.21,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,67.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,70.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,71.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,66.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,102.86,
.ANTI-JO-1 (CHG ONLY),1001536,CDM,300,RC,,,outpatient,,,73.75,36.88,,71.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.55,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,66.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,66.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,53.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,50.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,59.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,59.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,48.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.21,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,67.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,70.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,71.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,66.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,102.86,
.ANTI-CENTROMERE B ABS (CHG ONLY),1001537,CDM,300,RC,,,outpatient,,,73.75,36.88,,71.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.55,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,66.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,66.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,53.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,50.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,59.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,59.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,48.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.21,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,67.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,70.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,71.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,66.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,102.86,
"PANCREATIC ELASTASE, FECAL",1001540,CDM,300,RC,,,outpatient,,,497,248.5,,482.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,447.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,447.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,361.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,339.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,401.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,401.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,440.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,329.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,457.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,472.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,482.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,323.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,447.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,447.3,
"URINE CHLORIDE, 24 HR",1001541,CDM,300,RC,,,outpatient,,,19.75,9.88,,19.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,17.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.76,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,18.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.75,102.86,
.CELIAC PROFILE (LC-165126-CHG ONLY),1001542,CDM,300,RC,,,outpatient,,,116,58,,112.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,104.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,104.4,
HLA B27 DISEASE ASSOCIATION,1001543,CDM,300,RC,,,outpatient,,,50,25,,48.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,63.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,45,90,,,percent of total billed charges,Pays at 90% of total billed charges,45,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,74.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,100.35,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,46,92,,,percent of total billed charges,Pays at 92% of total billed charges,47.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,48.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,74.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,74.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,74.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,45,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,74.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,45,102.86,
.BEE ALLERGEN (1001544),1001545,CDM,300,RC,,,outpatient,,,85,42.5,,82.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.52,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,76.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,61.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,68.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.05,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,78.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,80.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,82.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,76.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,102.86,
.WASP/HORNET/JACKET ALLERGEN (1001544),1001546,CDM,300,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.52,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.05,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,102.86,
.ACETYLCHOLINE BINDING AB (1001550),1001551,CDM,300,RC,,,outpatient,,,99.5,49.75,,96.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.52,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,89.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,72.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,80.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.05,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,91.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,94.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,96.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,89.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,102.86,
.ACETYLCHOLINE BLOCKING/MOD ABS(1001550),1001552,CDM,300,RC,,,outpatient,,,99.5,49.75,,96.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.35,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,89.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,72.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,80.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.84,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,91.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,94.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,96.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,89.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.4,102.86,
.STRIATIOL AB (1001550),1001553,CDM,300,RC,,,outpatient,,,99.5,49.75,,96.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,89.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,72.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,80.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.27,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,91.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,94.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,96.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,89.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,102.86,
Testing for presence of drug,1001554,CDM,300,RC,,,outpatient,,,133.75,66.88,,129.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,97.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,107.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,88.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.89,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,123.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,127.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,129.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,120.38,
"CHLORIDE, RANDOM UR (NON-INTERF/UML)",1001555,CDM,300,RC,,,outpatient,,,19.75,9.88,,19.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,17.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.76,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,18.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.75,102.86,
VITAMIN B5,1001556,CDM,300,RC,,,outpatient,,,475.25,237.63,,460.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,427.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,427.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,345.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,324.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,383.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,383.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,421.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,315.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.03,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,437.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,451.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,460.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,308.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,427.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.06,427.73,
"ALPHA SUBUNIT, FREE",1001557,CDM,300,RC,,,outpatient,,,116,58,,112.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,104.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,84.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,93.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.31,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,106.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,104.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,104.4,
.A1-ANTITRYPSIN TOTAL (1001558),1001559,CDM,300,RC,,,outpatient,,,269,134.5,,260.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.65,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,242.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,242.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,195.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,183.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,217.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,217.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,238.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,178.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.14,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,247.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,255.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,260.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,174.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,242.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.44,242.1,
.A1-ANTITRYPSN GENOTYPE (1001558),1001560,CDM,300,RC,,,outpatient,,,269.25,134.63,,261.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.83,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,242.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,242.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,195.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,183.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,43.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,217.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,217.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,238.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,178.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,58.93,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,247.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,255.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,261.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,175.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,43.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,43.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,43.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,242.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,43.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,43.65,242.33,
".5-HIAA, URINE (1001561)",1001562,CDM,300,RC,,,outpatient,,,12.5,6.25,,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.18,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.42,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,11.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.25,102.86,
Test to measure creatinine in the urine,1001563,CDM,300,RC,,,outpatient,,,11.75,5.88,,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.99,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,10.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,102.86,
RA FACTOR QUANTITATIVE,1001564,CDM,300,RC,,,outpatient,,,7.25,3.63,,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.65,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,6.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.67,102.86,
ANTI-DSE B ABS,1001565,CDM,300,RC,,,outpatient,,,35,17.5,,33.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.48,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,31.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.89,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,32.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.25,102.86,
.MYCOBACTERIUM ID BY GC (CHG ONLY),1001566,CDM,300,RC,,,outpatient,,,255.25,127.63,,247.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.86,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,229.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,229.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,185.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,174.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,206.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,169.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.9,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,234.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,242.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,247.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,165.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,229.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.52,229.73,
"FDP, PLASMA",1001567,CDM,300,RC,,,outpatient,,,34.25,17.13,,33.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.97,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.3,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,31.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,32.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.89,102.86,
Blood test to diagnose rheumatoid arthritis,1001569,CDM,300,RC,,,outpatient,,,134.75,67.38,,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,98.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.48,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,123.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.95,121.28,
.RA FACTOR (1001568),1001570,CDM,300,RC,,,outpatient,,,134.75,67.38,,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,98.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.65,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,123.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.67,121.28,
.FOOD ALLERGEN SINGLE (1001571),1001572,CDM,300,RC,,,outpatient,,,54.5,27.25,,52.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.52,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,49.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,39.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,43.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.05,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,50.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,51.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,52.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,102.86,
.FOOD ALLERGEN ADDITIOL (1001571),1001573,CDM,300,RC,,,outpatient,,,54.75,27.38,,53.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.52,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,49.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,39.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,44.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.05,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,50.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,52.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,53.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,102.86,
RISPERIDONE,1001574,CDM,300,RC,,,outpatient,,,221.75,110.88,,215.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,133.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,199.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,199.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,151.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,133.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,179,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,179,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,196.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,147.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,179.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,204.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,210.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,215.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,144.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,133.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,133.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,199.58,
HALOPERIDOL,1001575,CDM,300,RC,,,outpatient,,,44.25,22.13,,42.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.3,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,40.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,42.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,39.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.78,102.86,
"BENZODIAZEPINE CONFIRM, QNT, SERUM",1001576,CDM,300,RC,,,outpatient,,,339.75,169.88,,329.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,203.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,305.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,305.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,231.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,203.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,274.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,274.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,301.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,225.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,275.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,312.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,322.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,329.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,220.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,203.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,305.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,203.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,305.78,
"C1 ESTERASE INHIBITOR AG, QNT",1001577,CDM,300,RC,,,outpatient,,,20.5,10.25,,19.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,18.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.2,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,18.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12,102.86,
"C1 ESTERASE INHIBITOR, FUNCTIOL",1001578,CDM,300,RC,,,outpatient,,,54.75,27.38,,53.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,49.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,39.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,44.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.2,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,50.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,52.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,53.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12,102.86,
.HGB ELECTROPHORESIS (1001579),1001580,CDM,300,RC,,,outpatient,,,10.75,5.38,,10.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.65,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.38,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,9.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.68,102.86,
.HGB SOLUBILITY (1001579),1001581,CDM,300,RC,,,outpatient,,,10.75,5.38,,10.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.77,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.44,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,9.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.51,102.86,
Blood test to monitor vitamin D levels,1001582,CDM,300,RC,,,outpatient,,,183.5,91.75,,178,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.65,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,165.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,133.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,125.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,148.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,39.96,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,168.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,174.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,178,97,,,percent of total billed charges,Pays at 97% of total billed charges,119.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,165.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.6,165.15,
Testing for presence of drug,1001583,CDM,300,RC,,,outpatient,,,321.75,160.88,,312.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,289.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,289.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,234.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,219.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,259.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,259.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,285.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,213.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.89,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,296.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,305.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,312.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,209.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,289.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,289.58,
"TESTOSTERONE, WOMEN/CHILD",1001584,CDM,300,RC,,,outpatient,,,11.75,5.88,,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.84,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,10.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.58,102.86,
"HCV, QNT, R PCR, REFLEX GENOTYPE",1001585,CDM,300,RC,,,outpatient,,,264.5,132.25,,256.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.13,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,238.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,238.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,192.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,180.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,213.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,213.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,234.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,175.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,57.83,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,243.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,251.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,256.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,171.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,238.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.84,238.05,
.HSV CULTURE (1001586),1001587,CDM,300,RC,,,outpatient,,,45,22.5,,43.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,40.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.41,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,41.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,42.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,43.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,19.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.56,102.86,
.VZS CULTURE (1001586),1001588,CDM,300,RC,,,outpatient,,,45,22.5,,43.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,40.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,45.71,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,41.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,42.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,43.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,33.86,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.86,102.86,
"BORDETELLA PERTUSSIS ABS, IGG",1001589,CDM,300,RC,,,outpatient,,,45.5,22.75,,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.81,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,41.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.19,102.86,
AMMONIA (LABCORP),1001590,CDM,300,RC,,,outpatient,,,122.25,61.13,,118.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,110.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,88.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,98.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.67,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,112.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,118.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,110.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.57,110.03,
Testing for presence of drug,1001591,CDM,300,RC,,,outpatient,,,474.75,237.38,,460.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,427.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,427.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,345.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,324.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,383.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,383.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,420.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,314.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.89,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,436.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,451.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,460.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,308.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,427.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,427.28,
"ANTIADREL ABS, QNT",1001592,CDM,300,RC,,,outpatient,,,82.75,41.38,,80.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,60.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,66.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.27,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,76.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,102.86,
.B PERTUSSIS IGA (1001593),1001594,CDM,300,RC,,,outpatient,,,89.25,44.63,,86.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,80.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,64.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,72.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.81,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,82.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,84.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,86.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,80.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.19,102.86,
.B PERTUSSIS IGG (1001593),1001595,CDM,300,RC,,,outpatient,,,88.75,44.38,,86.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,79.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,64.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,71.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.81,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,81.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,84.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,86.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,79.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.19,102.86,
.B PERTUSSIS IGM (1001593),1001596,CDM,300,RC,,,outpatient,,,88.75,44.38,,86.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,79.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,64.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,71.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.81,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,81.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,84.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,86.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,79.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.19,102.86,
.CK (1001597),1001598,CDM,300,RC,,,outpatient,,,5.25,2.63,,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.64,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.79,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,4.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.73,102.86,
.CK ISOENZYMES(1001597),1001599,CDM,300,RC,,,outpatient,,,5.5,2.75,,5.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.08,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,5.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.95,102.86,
LEFLUNOMIDE,1001600,CDM,300,RC,,,outpatient,,,402.5,201.25,,390.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,120.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,362.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,362.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,292.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,274.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,324.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,324.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,356.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,266.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,52.07,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,370.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,382.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,390.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,261.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,362.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,38.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.57,362.25,
"CYSTIC FIBROSIS PROFILE, 32 MUTATIONS",1001601,CDM,300,RC,,,outpatient,,,238.75,119.38,,231.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,556.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,434.15,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,214.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,214.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,556.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,173.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,162.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,556.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,192.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,192.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,211.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,158.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,751.41,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,219.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,226.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,231.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,556.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,556.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,556.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,214.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,556.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,556.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90,556.6,
"PARASITE IDENTIFICATION, WORM",1001602,CDM,300,RC,,,outpatient,,,16.5,8.25,,16.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.71,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.82,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,15.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.31,102.86,
.TISSUE CULTURE (1001603),1001604,CDM,300,RC,,,outpatient,,,324.5,162.25,,314.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,116.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,100.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,292.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,292.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,116.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,236.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,221.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,116.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,261.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,261.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,215.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,157.26,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,298.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,308.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,314.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,210.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,116.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,116.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,116.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,292.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,116.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,116.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90,292.05,
.KAROTYPE COUNTS (1001603),1001605,CDM,300,RC,,,outpatient,,,324.5,162.25,,314.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,125.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,108.02,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,292.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,292.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,236.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,221.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,125.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,261.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,261.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,215.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,169.41,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,298.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,308.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,314.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,210.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,125.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,125.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,125.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,292.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,125.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90,292.05,
A lab test used to detect bacteria or fungi in a sample taken from the site of a suspected infection,1001606,CDM,300,RC,,,outpatient,,,25.25,12.63,,24.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.71,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.76,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,23.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,102.86,
"HCG, HYPERGLYCOSYLATED",1001607,CDM,300,RC,,,outpatient,,,452.25,226.13,,438.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,407.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,407.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,329.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,308.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,365.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,365.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,400.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,299.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.06,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,416.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,429.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,438.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,293.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,407.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.12,407.03,
Blood test to monitor vitamin D levels,1001608,CDM,300,RC,,,outpatient,,,214.5,107.25,,208.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.65,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,193.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,193.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,156.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,146.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,173.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,173.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,190.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,142.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,39.96,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,197.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,203.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,208.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,193.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.6,193.05,
BORDETELLA PERTUSSIS ABS IGM,1001609,CDM,300,RC,,,outpatient,,,45.5,22.75,,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.81,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,41.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.19,102.86,
"NMO, IGG AUTOANTIBODIES",1001610,CDM,300,RC,,,outpatient,,,1329,664.5,,1289.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1196.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,1196.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,966.98,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,907.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,1072.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1072.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1177.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,881.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.31,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,1222.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,1262.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,1289.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,863.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,1196.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,1196.1,
"TESTOSTERONE, FREE, TOTAL, BIOAVAILABLE",1001611,CDM,300,RC,,,outpatient,,,58.25,29.13,,56.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,44.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,52.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,47.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.23,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,53.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,55.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,56.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,52.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,51.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.28,102.86,
"CRYOGLOBULIN QUAL, REFLEX TO QNT",1001613,CDM,300,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.6,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.73,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,102.86,
.DRVVT MIX (RFLX CHG 1000950),1001614,CDM,300,RC,,,outpatient,,,58.25,29.13,,56.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.6,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,52.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,47.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.73,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,53.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,55.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,56.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,52.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,102.86,
.DRVVT CONFIRM (RFLX CHG 1000950),1001615,CDM,300,RC,,,outpatient,,,58.25,29.13,,56.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.3,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,52.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,47.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.93,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,53.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,55.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,56.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,52.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.58,102.86,
ISOHEMAGGLUTININ TITER,1001616,CDM,300,RC,,,outpatient,,,77.5,38.75,,75.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,69.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,56.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,51.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.84,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,71.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,73.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,75.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,69.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.77,102.86,
.B CELL TOTAL (1001618),1001619,CDM,300,RC,,,outpatient,,,97.25,48.63,,94.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,87.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,70.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,66.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,78.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,64.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,50.94,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,89.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,92.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,94.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,87.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.73,102.86,
.NK CELL TOTAL (1001618),1001620,CDM,300,RC,,,outpatient,,,97.25,48.63,,94.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,87.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,70.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,66.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,78.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,64.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,50.94,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,89.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,92.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,94.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,87.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.73,102.86,
.T CELL TOTAL (1001618),1001621,CDM,300,RC,,,outpatient,,,97.25,48.63,,94.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,87.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,70.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,66.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,78.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,64.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,50.94,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,89.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,92.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,94.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,87.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.73,102.86,
.ABSOLUTE CD4 & CD8 (1001618),1001622,CDM,300,RC,,,outpatient,,,97.75,48.88,,94.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,87.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,71.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,66.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,46.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,78.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,64.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,63.42,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,89.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,92.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,94.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,46.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,87.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,46.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.98,102.86,
"MANGANESE, WHOLE BLD",1001623,CDM,300,RC,,,outpatient,,,71.75,35.88,,69.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.32,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,52.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,57.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.98,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,66.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,68.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,26.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.65,102.86,
.TOTAL PROTEIN (1001624),1001625,CDM,300,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.17,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.95,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.67,102.86,
.PROTEIN ELECTROPH (1001624),1001626,CDM,300,RC,,,outpatient,,,9.25,4.63,,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.5,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,8.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.33,102.86,
Blood test for an STD,1001627,CDM,300,RC,,,outpatient,,,196,98,,190.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,176.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,176.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,142.61,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,133.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,158.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,158.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,173.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,129.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,180.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,186.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,190.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,127.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,176.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,176.4,
JAK2 EXON 12-15 MUTATION ALYSIS,1001628,CDM,300,RC,,,outpatient,,,1033,516.5,,1002.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,185.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,309.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,929.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,929.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,185.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,751.61,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,705.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,185.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,833.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,833.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,915.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,684.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,250.02,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,950.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,981.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,1002.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,671.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,185.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,185.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,185.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,929.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,185.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,185.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90,929.7,
.KAPPA (1001629),1001630,CDM,300,RC,,,outpatient,,,40.75,20.38,,39.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.79,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.36,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,37.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.6,102.86,
.LAMBDA (1001629),1001631,CDM,300,RC,,,outpatient,,,40.5,20.25,,39.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.79,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,36.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.36,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,37.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.6,102.86,
.OXY (RFLX CHG 1000905),1001632,CDM,300,RC,,,outpatient,,,80.75,40.38,,78.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,72.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,55.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,65.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,74.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,76.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,78.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.45,102.86,
.BARB (RFLX CHG 1000905),1001633,CDM,300,RC,,,outpatient,,,80.75,40.38,,78.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,72.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,55.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,65.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,74.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,76.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,78.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.45,102.86,
.OPIATE (RFLX CHG 1000905),1001634,CDM,300,RC,,,outpatient,,,80.75,40.38,,78.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,72.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,55.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,65.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,74.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,76.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,78.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.45,102.86,
C-TELOPEPTIDE,1001635,CDM,300,RC,,,outpatient,,,161.25,80.63,,156.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.19,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,145.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,145.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,117.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,130.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,106.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.22,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,148.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,153.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,156.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,145.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.68,145.13,
Testing for presence of drug,1001636,CDM,300,RC,,,outpatient,,,133.75,66.88,,129.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,97.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,107.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,88.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.89,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,123.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,127.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,129.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,120.38,
"SYNTHETIC CANBINOID, WHOLE BLD",1001637,CDM,300,RC,,,outpatient,,,301.5,150.75,,292.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,180.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,271.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,271.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,180.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,219.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,205.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,180.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,267.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,199.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,244.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,277.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,286.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,292.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,195.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,180.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,180.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,180.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,271.35,
.DS D (1001638),1001639,CDM,300,RC,,,outpatient,,,42,21,,40.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,37.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.55,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,38.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,39.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.74,102.86,
.RNP AB (1001638),1001640,CDM,300,RC,,,outpatient,,,41.75,20.88,,40.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.55,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.21,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,38.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,39.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,102.86,
.SLE ABS (1001638),1001641,CDM,300,RC,,,outpatient,,,41.75,20.88,,40.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.55,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.21,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,38.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,39.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,102.86,
"BARBITURATE CONFIRM, URINE",1001642,CDM,300,RC,,,outpatient,,,47.75,23.88,,46.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,42.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,38.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,43.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,45.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,46.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.65,102.86,
HEPARIN INDUCED PLT ANTIBODY REFLEX,1001643,CDM,300,RC,,,outpatient,,,172.5,86.25,,167.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,155.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,125.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,117.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,139.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.8,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,158.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,163.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,167.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,155.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.37,155.25,
.FLOW CYTO 1ST MARKER (1001644),1001645,CDM,300,RC,,,outpatient,,,110.25,55.13,,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,66.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,75.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,66.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,73.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,89.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,101.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,104.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,66.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,66.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,66.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
.FLOW CYTO 2ND MARKER (1001644),1001646,CDM,300,RC,,,outpatient,,,140.25,70.13,,136.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,126.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,126.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,124.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,113.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,133.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,136.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,84.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,126.23,
.FLOW CYTO 3RD MARKER (1001644),1001647,CDM,300,RC,,,outpatient,,,140.25,70.13,,136.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,126.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,126.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,124.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,113.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,133.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,136.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,84.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,126.23,
.TRICYCLIC METABOLITES (1001648),1001649,CDM,300,RC,,,outpatient,,,137.25,68.63,,133.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.53,
.MUSCLE RELAXANTS (1001648),1001650,CDM,300,RC,,,outpatient,,,137.25,68.63,,133.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.53,
DOXEPIN,1001651,CDM,300,RC,,,outpatient,,,42.5,21.25,,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,39.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.5,102.86,
FREE FATTY ACIDS,1001652,CDM,300,RC,,,outpatient,,,31.75,15.88,,30.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.64,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,28.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.34,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,29.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,30.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.77,102.86,
"ORGANIC ACID ALYSIS, URINE",1001653,CDM,300,RC,,,outpatient,,,138,69,,133.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,124.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,124.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,100.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,94.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,111.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,111.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,122.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.21,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,126.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,131.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,124.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.45,124.2,
"ACYLCARNITINE PROFILE, QNT, PLASMA",1001654,CDM,300,RC,,,outpatient,,,444.75,222.38,,431.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,400.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,323.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,303.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,359,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,359,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,394.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,294.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.77,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,409.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,422.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,431.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,289.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,400.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.87,400.28,
Test to determine levels of immunoglobulins in the blood,1001655,CDM,300,RC,,,outpatient,,,20.5,10.25,,19.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,18.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.56,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,18.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,102.86,
"LDH, FLUID/CSF",1001656,CDM,300,RC,,,outpatient,,,8.75,4.38,,8.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.23,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.15,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,8.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.04,102.86,
"REDUCING SUBSTANCE, FECES (UML)",1001657,CDM,300,RC,,,outpatient,,,49.75,24.88,,48.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.77,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,44.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,33.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,32.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.43,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,45.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,47.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,48.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,44.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.5,102.86,
"HEPATITIS A IGG, AB (UML)",1001658,CDM,300,RC,,,outpatient,,,206.75,103.38,,200.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.16,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,186.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,186.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,150.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,141.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,166.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,166.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,183.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,137.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.39,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,190.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,196.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,200.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,134.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,186.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,186.08,
Blood test to measure average blood glucose levels for past 2-3 months,1001659,CDM,300,RC,,,outpatient,,,79,39.5,,76.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,71.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,57.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,53.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,63.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.11,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,72.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,76.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,71.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.71,102.86,
.PFA EPI (1000602),1001663,CDM,300,RC,,,outpatient,,,52.75,26.38,,51.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.63,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,48.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,24.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.91,102.86,
.PFA ADP (1000602),1001664,CDM,300,RC,,,outpatient,,,52.75,26.38,,51.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.63,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,48.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,24.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.91,102.86,
.A1-ANTITRYPSIN TOTAL (1001700),1001701,CDM,300,RC,,,outpatient,,,20.5,10.25,,19.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.65,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,18.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.14,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,18.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.44,102.86,
.A1-ANTITRYPSIN TYPING (1001700),1001702,CDM,300,RC,,,outpatient,,,20.75,10.38,,20.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.52,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,19.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.46,102.86,
ANTI-JO-1,1001703,CDM,300,RC,,,outpatient,,,21,10.5,,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.55,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.21,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,19.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,102.86,
LORAZEPAM,1001704,CDM,300,RC,,,outpatient,,,190.75,95.38,,185.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,171.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,171.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,130.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,153.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,153.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,169.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,126.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,154.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,175.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,181.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,185.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,123.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,171.68,
"ALBUMIN, FLUID",1001705,CDM,300,RC,,,outpatient,,,52.25,26.13,,50.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,47.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,35.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.5,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,48.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,49.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,50.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,7.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.78,102.86,
"LIPASE, FLUID",1001706,CDM,300,RC,,,outpatient,,,64.5,32.25,,62.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.97,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,52.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.3,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,59.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,62.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,58.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.89,102.86,
.HGE (1001707),1001708,CDM,300,RC,,,outpatient,,,253.75,126.88,,246.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,228.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,228.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,184.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,173.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,204.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,204.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,224.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,168.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,233.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,241.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,246.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,228.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,228.38,
.HGA (1001707),1001709,CDM,300,RC,,,outpatient,,,255.25,127.63,,247.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,229.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,229.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,185.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,174.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,206.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,169.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,234.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,242.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,247.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,165.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,229.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,229.73,
"ROCKY MT SPOTTED FEVER, IGM",1001710,CDM,300,RC,,,outpatient,,,46.5,23.25,,45.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.78,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,41.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.12,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,42.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.35,102.86,
"ROCKY MT SPOTTED FEVER, IGG",1001711,CDM,300,RC,,,outpatient,,,38.25,19.13,,37.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.78,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.12,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,35.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,36.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.35,102.86,
VORICOZOLE,1001712,CDM,300,RC,,,outpatient,,,955.75,477.88,,927.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,286.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,860.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,860.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,695.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,652.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,771.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,771.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,846.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,633.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.6,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,879.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,907.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,927.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,621.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,860.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,27.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.11,860.18,
.DRVVT (1001714),1001714,CDM,300,RC,,,outpatient,,,46.5,23.25,,45.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.3,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,41.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.93,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,42.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.58,102.86,
.PTT-LA (1001714),1001715,CDM,300,RC,,,outpatient,,,45.75,22.88,,44.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.6,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,41.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.73,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,42.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,102.86,
Chemical test of the blood to measure presence or concentration of a substance in the blood,1001716,CDM,300,RC,,,outpatient,,,57.5,28.75,,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,52.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,54.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,102.86,
"CORTISOL, AM (LC-104018)",1001717,CDM,300,RC,,,outpatient,,,23.75,11.88,,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.13,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.01,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,21.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.3,102.86,
"HYDROCODONE & METABOLITE, URINE",1001718,CDM,300,RC,,,outpatient,,,233.75,116.88,,226.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,210.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,207.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,215.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,222.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.38,
CLONIDINE LEVEL SERUM,1001719,CDM,300,RC,,,outpatient,,,406.25,203.13,,394.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,243.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,365.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,365.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,243.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,295.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,277.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,243.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,327.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,327.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,359.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,269.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,329.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,373.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,385.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,394.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,264.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,243.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,365.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,243.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,243.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,365.63,
THROMBIN TIME,1001720,CDM,300,RC,,,outpatient,,,40.25,20.13,,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.79,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,37.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.77,102.86,
T SPOT (LC-NONINTERFACED),1001721,CDM,300,RC,,,outpatient,,,271.75,135.88,,263.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,100,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,78,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,244.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,244.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,197.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,185.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,219.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,219.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,240.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,180.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,250.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,258.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,263.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,176.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,100,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,100,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,100,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,244.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,100,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90,244.58,
CANDIDA ANTIGEN,1001722,CDM,300,RC,,,outpatient,,,301,150.5,,291.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,270.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,270.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,219.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,205.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,242.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,242.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,266.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,199.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.69,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,276.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,285.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,291.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,195.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,270.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.07,270.9,
"BK VIRUS QNT, URINE, PCR",1001723,CDM,300,RC,,,outpatient,,,713.25,356.63,,691.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.13,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,641.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,641.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,518.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,486.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,575.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,575.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,632.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,472.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,57.83,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,656.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,677.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,691.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,463.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,641.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,42.84,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.84,641.93,
.AFB CHROMATOGRAPHY (GLC/HPLC),1001724,CDM,300,RC,,,outpatient,,,247.5,123.75,,240.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.86,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,222.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,180.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,168.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,199.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,199.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,219.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,164.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.9,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,227.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,235.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,240.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,160.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,222.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.52,222.75,
.GENOMIC INTERROGATION (CHG ONLY),1001725,CDM,300,RC,,,outpatient,,,2373,1186.5,,2301.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,1160,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,904.8,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2135.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2135.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1160,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,1726.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1619.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1160,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,1915.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1915.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2102.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1573.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1566,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,2183.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,2254.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,2301.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,1542.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,1160,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,1160,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,1160,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2135.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1160,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,1160,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90,2135.7,
.ADD HIGH RESOLUTION STUDY (CHG ONLY),1001726,CDM,300,RC,,,outpatient,,,2373,1186.5,,2301.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2135.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2135.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,1726.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1619.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,34.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,1915.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1915.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2102.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1573.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,46.48,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,2183.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,2254.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,2301.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,1542.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,34.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2135.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,34.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.43,2135.7,
Blood test to diagnose mononucleosis,1001727,CDM,300,RC,,,outpatient,,,27,13.5,,26.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.49,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,24.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.14,102.86,
Blood test to determine existence of certain bacterium that causes syphilis,1001728,CDM,300,RC,,,outpatient,,,18.75,9.38,,18.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,16.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.87,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,17.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.24,102.86,
.ARSENIC BLD (1001729),1001730,CDM,300,RC,,,outpatient,,,45,22.5,,43.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.97,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,40.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.97,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.97,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.61,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,41.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,42.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,43.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.97,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.97,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.97,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.97,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.97,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.97,102.86,
Blood test to determine the concentration of lead in the blood,1001731,CDM,300,RC,,,outpatient,,,44.75,22.38,,43.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,40.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.35,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,41.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,42.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,43.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.11,102.86,
.MERCURY BLD (1001729),1001732,CDM,300,RC,,,outpatient,,,44.75,22.38,,43.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.09,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,40.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.95,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,41.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,42.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,43.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.26,102.86,
.HLA AG (1001733),1001734,CDM,300,RC,,,outpatient,,,546.75,273.38,,530.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,79.57,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,492.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,492.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,397.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,373.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,441.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,441.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,484.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,362.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.9,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,503.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,519.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,530.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,355.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,94.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,94.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,492.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,94.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90,492.08,
.HLA ALLELE (1001733),1001735,CDM,300,RC,,,outpatient,,,547,273.5,,530.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,94.58,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,492.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,492.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,398,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,373.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,109.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,441.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,441.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,484.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,362.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,147.33,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,503.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,519.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,530.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,355.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,109.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,109.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,109.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,492.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,109.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90,492.3,
"PYRUVIC ACID, WB",1001736,CDM,300,RC,,,outpatient,,,19.25,9.63,,18.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.29,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,17.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.55,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,17.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.48,102.86,
QUETIAPINE,1001737,CDM,300,RC,,,outpatient,,,160.75,80.38,,155.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,144.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,144.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,109.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,96.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,129.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,106.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,130.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,147.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,152.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,155.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,96.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,96.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,144.68,
.LYME AB TOTAL (1001738),1001739,CDM,300,RC,,,outpatient,,,38.5,19.25,,37.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.76,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,34.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.99,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,35.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,36.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.03,102.86,
.LYME AB IGM(1001738),1001740,CDM,300,RC,,,outpatient,,,38.5,19.25,,37.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.76,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,34.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.99,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,35.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,36.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.03,102.86,
Testing for presence of drug,1001741,CDM,300,RC,,,outpatient,,,441.25,220.63,,428.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,397.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,397.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,321.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,301.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,356.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,356.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,390.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,292.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.89,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,405.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,419.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,428.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,286.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,397.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,397.13,
"MDMA, BLOOD",1001742,CDM,300,RC,,,outpatient,,,347,173.5,,336.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,208.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,312.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,312.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,208.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,236.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,208.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,280.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,280.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,307.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,230.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,281.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,319.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,329.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,336.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,225.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,208.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,312.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,208.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,208.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,312.3,
.CHG ONLY HAEMOPHILIS (UML),1001743,CDM,300,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.97,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.1,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,7.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.48,102.86,
.CHG ONLY AEROBIC ID (UML),1001744,CDM,300,RC,,,outpatient,,,100.5,50.25,,97.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,90.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,73.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,68.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,81.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,66.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.91,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,92.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,95.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,97.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.08,102.86,
.CHG ONLY AEROBIC SENS 1 (UML),1001745,CDM,300,RC,,,outpatient,,,105.25,52.63,,102.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,76.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,71.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,84.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,69.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.41,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,96.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,99.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,102.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.75,102.86,
.CHG ONLY AEROBIC SENS 2 (UML),1001746,CDM,300,RC,,,outpatient,,,132.5,66.25,,128.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,119.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,96.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,90.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,106.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,117.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.41,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,121.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,125.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,128.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,119.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.75,119.25,
.CHG ONLY AEROBIC SENS 3 (UML),1001747,CDM,300,RC,,,outpatient,,,168,84,,162.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,151.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,151.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,122.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,135.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,111.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.41,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,154.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,159.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,151.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.75,151.2,
.CHG ONLY AEROBIC SENS 4 (UML),1001748,CDM,300,RC,,,outpatient,,,203.75,101.88,,197.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,183.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,183.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,148.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,139.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,164.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,164.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,180.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,135.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.41,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,187.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,193.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,197.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,132.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,183.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.75,183.38,
HCV FIBROSURE,1001749,CDM,300,RC,,,outpatient,,,287.25,143.63,,278.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,56.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,258.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,258.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,209,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,196.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,231.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,231.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,254.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,190.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.46,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,264.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,272.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,278.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,186.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,72.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,72.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,258.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,72.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,72.19,258.53,
"BENZO & METABOLITE CONF, URINE",1001750,CDM,300,RC,,,outpatient,,,266.25,133.13,,258.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,239.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,239.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,181.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,214.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,235.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,176.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,215.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,244.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,252.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,258.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,173.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,239.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,239.63,
Blood test indicating infection with Hepatitis B,1001751,CDM,300,RC,,,outpatient,,,11.5,5.75,,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.27,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,10.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.35,102.86,
Blood test to determine infection with Hepatitis C,1001752,CDM,300,RC,,,outpatient,,,18.75,9.38,,18.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,16.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.26,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,17.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.27,102.86,
TOXOCARA TITER,1001754,CDM,300,RC,,,outpatient,,,358,179,,347.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,322.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,322.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,260.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,244.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,288.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,288.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,317.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,237.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.56,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,329.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,340.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,347.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,232.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,322.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.01,322.2,
"STRONGYLOIDES, IGG AB",1001755,CDM,300,RC,,,outpatient,,,205.5,102.75,,199.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,184.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,184.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,149.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,140.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,165.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,165.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,136.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.56,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,189.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,195.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,199.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,133.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,184.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.01,184.95,
.A NIGER ABS (1001756),1001757,CDM,300,RC,,,outpatient,,,67.75,33.88,,65.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,54.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,44.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.32,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,62.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,65.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.05,102.86,
.A FLAVUS ABS (1001756),1001758,CDM,300,RC,,,outpatient,,,67.75,33.88,,65.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,54.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,44.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.32,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,62.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,65.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.05,102.86,
.A FUMIGATUS ABS (1001756),1001759,CDM,300,RC,,,outpatient,,,67.75,33.88,,65.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,54.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,44.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.32,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,62.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,65.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.05,102.86,
.COXSACKIE IGG (1001761),1001762,CDM,300,RC,,,outpatient,,,70.25,35.13,,68.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.29,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,56.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.59,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,64.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,68.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.03,102.86,
.COXSACKIE IGM (1001761),1001763,CDM,300,RC,,,outpatient,,,70.25,35.13,,68.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.29,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,56.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.59,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,64.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,68.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.03,102.86,
FLOW CYTO INTERP 16 OR MORE-CHG ONLY,1001764,CDM,300,RC,,,outpatient,,,451.5,225.75,,437.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,270.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,406.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,406.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,270.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,308.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,270.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,364.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,364.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,400.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,299.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,365.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,415.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,428.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,437.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,293.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,270.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,270.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,270.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,406.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,270.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,270.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,406.35,
".LYME, IGG WB-RFLX CHG ONLY",1001765,CDM,300,RC,,,outpatient,,,334.75,167.38,,324.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,301.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,301.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,243.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,228.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,270.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,270.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,296.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,221.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.91,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,307.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,318.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,324.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,217.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,301.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.49,301.28,
"SULFONYLUREA, SERUM",1001766,CDM,300,RC,,,outpatient,,,374,187,,362.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,336.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,336.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,272.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,255.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,301.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,301.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,331.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,247.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,302.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,344.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,355.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,362.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,243.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,336.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,336.6,
.PARVO IGG (1001767),1001768,CDM,300,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.29,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.03,102.86,
.PARVO IGM (1001767),1001769,CDM,300,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.29,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.03,102.86,
.YEAST CF (1001771),1001772,CDM,300,RC,,,outpatient,,,56,28,,54.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.83,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,50.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,45.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.62,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,51.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,53.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.79,102.86,
.MYCELIAL CF & ID (1001771),1001773,CDM,300,RC,,,outpatient,,,112.25,56.13,,108.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.83,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,101.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,81.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.62,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,103.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,101.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.79,102.86,
COCCIDIOIDES AB RFLX (NON-INTERF),1001774,CDM,300,RC,,,outpatient,,,38,19,,36.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,34.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.48,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,34.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,36.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,36.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.47,102.86,
Chemical test of the blood to measure presence or concentration of a substance in the blood,1001775,CDM,300,RC,,,outpatient,,,95.75,47.88,,92.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,86.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,69.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,65.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,77.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,63.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,88.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,90.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,92.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,86.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,102.86,
NOTCH3 (CADASIL) - MAYO,1001776,CDM,300,RC,,,outpatient,,,5632.5,2816.25,,5463.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,282.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,220.65,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,5069.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,5069.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,282.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4098.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3844.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,282.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4546.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4546.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4990.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3734.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,381.89,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,5181.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,5350.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,5463.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,3661.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,282.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,282.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,282.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5069.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,282.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,282.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90,5069.25,
VASOACTIVE INTESTIL POLYPEPTIDE (VIP),1001777,CDM,300,RC,,,outpatient,,,151.75,75.88,,147.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,136.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,110.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,103.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,122.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,122.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,100.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.7,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,139.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,144.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,147.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,136.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,35.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.33,136.58,
"METHYLPHENIDATE, SERUM",1001778,CDM,300,RC,,,outpatient,,,79,39.5,,76.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,71.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,53.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,63.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,72.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,76.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.4,102.86,
Blood test to determine if antibodies exist for measles,1001779,CDM,300,RC,,,outpatient,,,10,5,,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.16,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.39,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,9.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9,102.86,
Blood test to determine if antibodies exist for measles,1001780,CDM,300,RC,,,outpatient,,,10,5,,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.16,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.39,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,9.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9,102.86,
Blood test to determine if antibodies exist for measles,1001781,CDM,300,RC,,,outpatient,,,10,5,,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.16,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.39,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,9.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9,102.86,
Acute hepatitis panel,1001782,CDM,300,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.29,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.3,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,47.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.5,102.86,
"THYROGLOBULIN, TUMOR MKR, RFLX",1001785,CDM,300,RC,,,outpatient,,,34.75,17.38,,33.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.78,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.48,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,31.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.91,102.86,
.HSV2 IGG SUPPLEMENT (RFLX CHG 1000885),1001786,CDM,300,RC,,,outpatient,,,123.5,61.75,,119.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.78,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,111.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,89.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,84.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,99.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,109.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.12,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,113.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,117.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,119.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,111.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.35,111.15,
A test used to determine which medications work on bacteria for fungi,1001787,CDM,300,RC,,,outpatient,,,41.25,20.63,,40.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.5,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,37.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.68,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,37.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,39.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.65,102.86,
".ANTIMIC SUSCEPT, MACBROTH M3-CHG ONLY",1001788,CDM,300,RC,,,outpatient,,,117.5,58.75,,113.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.76,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,105.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,85.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,80.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,94.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,104.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.96,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,108.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,111.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,105.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.64,105.75,
"AMIKACIN, TROUGH",1001789,CDM,300,RC,,,outpatient,,,30,15,,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.36,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,27.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.08,102.86,
"AMIKACIN, PEAK",1001790,CDM,300,RC,,,outpatient,,,30,15,,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.36,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,27.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.08,102.86,
Chemical test of the blood to measure presence or concentration of a substance in the blood,1001791,CDM,300,RC,,,outpatient,,,62.25,31.13,,60.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,56.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,45.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,42.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,57.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,59.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,60.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,56.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,102.86,
Blood test to measure a type of estrogen in the blood,1001793,CDM,300,RC,,,outpatient,,,73,36.5,,70.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,65.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,53.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,49.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,58.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,48.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,37.72,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,67.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,69.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,70.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,65.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,27.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.94,102.86,
.ESTRADIOL FREE (1001792),1001794,CDM,300,RC,,,outpatient,,,73,36.5,,70.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,65.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,49.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,48.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,59.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,67.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,69.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,70.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.8,102.86,
".VARICELLA ABS, IGG - PATIENT REQ",1001796,CDM,300,RC,,,outpatient,,,10,5,,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.16,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.39,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,9.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9,102.86,
.URINE DRUG SCREEN - PATIENT REQ,1001797,CDM,300,RC,,,outpatient,,,50,25,,48.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,45,90,,,percent of total billed charges,Pays at 90% of total billed charges,45,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.14,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,46,92,,,percent of total billed charges,Pays at 92% of total billed charges,47.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,48.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,45,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.14,102.86,
.HEP B SURFACE AB - PATIENT REQ,1001798,CDM,300,RC,,,outpatient,,,20,10,,19.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,18,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.24,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,18.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,19,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,13,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.99,102.86,
Urine pregncy test,1001799,CDM,300,RC,,,outpatient,,,10,5,,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.62,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,9.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.61,102.86,
".INFLUENZA, RAPID - PATIENT REQ",1001800,CDM,300,RC,,,outpatient,,,40,20,,38.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,74.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,36,90,,,percent of total billed charges,Pays at 90% of total billed charges,36,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,95.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,129.33,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,36.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,38,95,,,percent of total billed charges,Pays at 95% of total billed charges,38.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,26,65,,,percent of total billed charges,Pays at 65% of total billed charges,95.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,95.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,95.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,95.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36,102.86,
Testing for presence of drug,1001801,CDM,300,RC,,,outpatient,,,10,5,,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.89,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,9.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9,102.86,
.MMR TITERS - PATIENT REQ,1001802,CDM,300,RC,,,outpatient,,,45,22.5,,43.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,27,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,40.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,27,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,41.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,42.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,43.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,27,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,27,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,27,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27,90,
.APPTS IGA - 1001803,1001804,CDM,300,RC,,,outpatient,,,49.75,24.88,,48.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,44.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,33.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,32.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.69,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,45.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,47.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,48.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,44.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.07,102.86,
.APPTS IGG/IGM - 1001803,1001805,CDM,300,RC,,,outpatient,,,49.75,24.88,,48.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,44.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,33.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,32.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.69,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,45.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,47.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,48.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,44.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.07,102.86,
"PROTHROMBIN ABS, IGG",1001806,CDM,300,RC,,,outpatient,,,149.75,74.88,,145.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,134.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.78,
"CARBOXY HEMOGLOBIN, VENOUS",1001807,CDM,300,RC,,,outpatient,,,92.25,46.13,,89.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.68,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,83.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,67.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,62.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,74.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.63,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,84.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,83.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.32,102.86,
BILE ACIDS,1001808,CDM,300,RC,,,outpatient,,,41.5,20.75,,40.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,37.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.11,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,38.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,39.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.12,102.86,
"VITAMIN B2, WHOLE BLOOD",1001810,CDM,300,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.32,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,20.24,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.24,102.86,
AMINO ACID PROFILE,1001811,CDM,300,RC,,,outpatient,,,291.5,145.75,,282.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,212.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,198.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,235.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,235.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,258.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,193.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.77,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,268.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,276.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,282.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,189.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.87,262.35,
FACTOR VIII ACTIVITY,1001812,CDM,300,RC,,,outpatient,,,134.25,67.13,,130.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,120.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,97.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,108.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.17,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,123.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,127.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,130.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,120.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.9,120.83,
"CARNITINE, TOTAL & FREE",1001813,CDM,300,RC,,,outpatient,,,52.75,26.38,,51.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.77,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,48.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.87,102.86,
GAD65 AB ASSAY - MAYO,1001814,CDM,300,RC,,,outpatient,,,63.25,31.63,,61.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.38,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,56.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,23.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,31.82,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,58.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,60.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,61.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,23.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,56.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,23.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.57,102.86,
PURINES & PYRIMIDINES PANEL - MAYO,1001815,CDM,300,RC,,,outpatient,,,1131.5,565.75,,1097.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.79,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1018.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,1018.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,823.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,772.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,913.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,913.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1002.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,750.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32.52,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,1040.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,1074.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,1097.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,735.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,1018.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,24.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.09,1018.35,
.ACHR GANG NEUR AB (1001816),1001817,CDM,300,RC,,,outpatient,,,124.5,62.25,,120.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.35,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,112.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,84.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,100.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,82.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.84,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,114.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,118.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,120.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,112.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.4,112.05,
.K&CA CHANNEL AB (1001816),1001818,CDM,300,RC,,,outpatient,,,124.5,62.25,,120.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.35,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,112.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,84.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,100.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,82.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.84,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,114.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,118.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,120.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,112.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.4,112.05,
.AMPHIPHYSIN AB (1001816),1001819,CDM,300,RC,,,outpatient,,,125.5,62.75,,121.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,112.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,91.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,85.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,101.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,111.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,83.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.31,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,115.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,119.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,121.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,112.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,112.95,
.PURKINJE 1 AB (1001816),1001820,CDM,300,RC,,,outpatient,,,124.5,62.25,,120.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,112.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,84.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,100.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,82.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.27,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,114.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,118.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,120.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,112.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,112.05,
.PURK 2/3-NEURO ABS (1001816),1001821,CDM,300,RC,,,outpatient,,,124.5,62.25,,120.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,112.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,84.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,100.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,82.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.27,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,114.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,118.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,120.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,112.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,112.05,
.HGE IGG (1001822),1001823,CDM,300,RC,,,outpatient,,,65,32.5,,63.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,52.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.74,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,59.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.18,102.86,
.HGE IGM (1001822),1001824,CDM,300,RC,,,outpatient,,,65,32.5,,63.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,52.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.74,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,59.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.18,102.86,
.BABESIA IGG (1001825),1001826,CDM,300,RC,,,outpatient,,,94.75,47.38,,91.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,85.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,68.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,64.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,76.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,62.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.73,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,87.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,90.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,91.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,85.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.39,102.86,
.BABESIA IGM (1001825),1001827,CDM,300,RC,,,outpatient,,,94.75,47.38,,91.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,85.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,68.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,64.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,76.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,62.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.73,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,87.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,90.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,91.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,85.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.39,102.86,
"BETA-2 TRANSFERRIN, FLUID - MAYO",1001828,CDM,300,RC,,,outpatient,,,149.75,74.88,,145.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,108.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,29.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,120.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,39.62,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,137.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,29.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,134.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,29.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.35,134.78,
"CREATININE/GFR, RAPID",1001829,CDM,300,RC,,,outpatient,,,37,18.5,,35.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.91,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,34.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.12,102.86,
ANTIHISTONE ABS,1001830,CDM,300,RC,,,outpatient,,,47.75,23.88,,46.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.55,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,42.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.21,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,43.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,45.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,46.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,102.86,
"JC VIRUS D PCR, WHOLE BLD",1001831,CDM,300,RC,,,outpatient,,,433,216.5,,420.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,389.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,389.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,315.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,295.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,349.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,349.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,383.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,287.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,398.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,411.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,420.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,281.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,389.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,389.7,
"TOXOPLASMA GONDII ABS, IGM",1001832,CDM,300,RC,,,outpatient,,,34.75,17.38,,33.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.45,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,31.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.41,102.86,
"TOXOPLASMA GONDII ABS, IGG",1001833,CDM,300,RC,,,outpatient,,,34.75,17.38,,33.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.43,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,31.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.39,102.86,
DEXAMETHASONE,1001834,CDM,300,RC,,,outpatient,,,91,45.5,,88.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,81.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,62.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,60.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,73.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,83.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,86.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,88.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,54.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,54.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.6,102.86,
B2-MICROGLOBULIN,1001835,CDM,300,RC,,,outpatient,,,39,19.5,,37.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.02,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,35.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.84,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,35.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,37.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.18,102.86,
UREAPLASMA/MYCOPLASMA CULTURE,1001836,CDM,300,RC,,,outpatient,,,51.25,25.63,,49.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,46.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.78,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,47.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,48.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,49.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.39,102.86,
"CRYOFIBRINOGEN, QUAL",1001837,CDM,300,RC,,,outpatient,,,30.75,15.38,,29.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,27.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.09,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,28.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.14,102.86,
HUNTINGTON DISEASE GENETIC TESTING,1001838,CDM,300,RC,,,outpatient,,,638.5,319.25,,619.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,137,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,106.86,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,574.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,574.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,137,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,464.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,435.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,137,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,515.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,515.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,565.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,423.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,184.95,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,587.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,606.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,619.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,415.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,137,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,137,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,137,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,574.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,137,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,137,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90,574.65,
HYDROXYCHLOROQUINE,1001839,CDM,300,RC,,,outpatient,,,638.5,319.25,,619.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,383.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,574.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,574.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,383.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,464.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,435.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,383.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,515.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,515.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,565.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,423.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,517.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,587.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,606.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,619.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,415.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,383.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,383.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,383.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,574.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,383.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,383.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,574.65,
Chemical test of the blood to measure presence or concentration of a substance in the blood,1001841,CDM,300,RC,,,outpatient,,,67.5,33.75,,65.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,60.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,54.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,59.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,44.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,62.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,65.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,60.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,102.86,
.CPR SF(1001840),1001842,CDM,300,RC,,,outpatient,,,67.5,33.75,,65.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,60.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,54.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,59.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,44.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.99,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,62.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,65.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,60.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,102.86,
.HGB SF(1001840),1001843,CDM,300,RC,,,outpatient,,,67.25,33.63,,65.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.32,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,60.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,48.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,45.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,54.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,59.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,44.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.94,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,61.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,63.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,65.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,60.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.1,102.86,
.TG AB (1001844),1001845,CDM,300,RC,,,outpatient,,,38.5,19.25,,37.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.78,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,34.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.48,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,35.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,36.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.91,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.91,102.86,
.TG (1001844),1001846,CDM,300,RC,,,outpatient,,,38.75,19.38,,37.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,34.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.68,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,35.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,36.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.06,102.86,
"PHENCYCLIDINE CONFIRM, URINE",1001847,CDM,300,RC,,,outpatient,,,45,22.5,,43.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,27,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,40.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,27,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,41.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,42.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,43.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,27,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,27,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,27,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27,102.86,
"HEP B SURFACE AB, QUAL",1001848,CDM,300,RC,,,outpatient,,,26,13,,25.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,23.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.5,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,23.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.74,102.86,
CYSTICEROCSIS,1001849,CDM,300,RC,,,outpatient,,,271.75,135.88,,263.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,244.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,244.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,197.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,185.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,219.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,219.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,240.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,180.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.12,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,250.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,258.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,263.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,176.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,244.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.68,244.58,
.CHLAMYDIA CX (1001850),1001851,CDM,300,RC,,,outpatient,,,47.25,23.63,,45.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.98,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,42.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.46,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,43.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,19.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.6,102.86,
.CHLAMYDIA TYPING (1001850),1001852,CDM,300,RC,,,outpatient,,,13.75,6.88,,13.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.83,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,12.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.52,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,12.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.57,102.86,
"COVID-19, A (LABCORP)",1001853,CDM,300,RC,,,outpatient,,,216.5,108.25,,210.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,64.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,194.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,194.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,157.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,147.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,174.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,191.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,143.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.27,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,199.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,205.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,210.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,194.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.31,194.85,
PM-SCL ANTIBODIES,1001854,CDM,300,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.12,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.68,102.86,
.COVID-19 PCR (MON-WVUH),1001856,CDM,300,RC,,,outpatient,,,322.5,161.25,,312.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,96.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,290.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,290.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,234.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,220.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,260.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,260.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,285.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,213.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.27,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,296.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,306.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,312.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,209.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,290.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.31,290.25,
"COROVIRUS COVID-19 AB, IGA",1001857,CDM,300,RC,,,outpatient,,,108.25,54.13,,105,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,78.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,87.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,95.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,71.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.27,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,99.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,102.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,105,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.31,102.86,
"COROVIRUS COVID-19 AB, IGM",1001858,CDM,300,RC,,,outpatient,,,108.25,54.13,,105,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,78.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,87.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,95.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,71.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.27,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,99.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,102.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,105,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.31,102.86,
"COROVIRUS COVID-19 AB, IGG",1001859,CDM,300,RC,,,outpatient,,,108.25,54.13,,105,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,78.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,87.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,95.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,71.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,56.88,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,99.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,102.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,105,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.13,102.86,
.COVID-19 NP COLLECT (1001853-1856),1001860,CDM,300,RC,,,outpatient,,,26.75,13.38,,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,90,
VITAMIN K,1001861,CDM,300,RC,,,outpatient,,,378.75,189.38,,367.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.72,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,340.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,340.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.72,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,275.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,258.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.72,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,305.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,305.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,335.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,251.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.52,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,348.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,359.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,367.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,246.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.72,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.72,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.72,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,340.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.72,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.72,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.72,340.88,
"COVID-19, A (PMH)",1001862,CDM,300,RC,,,outpatient,,,96,48,,93.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,86.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,69.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,65.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,77.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,63.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.27,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,88.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,91.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,93.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,86.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.31,102.86,
HELPER T-LYMPHOCYTE MARKER CD4,1001863,CDM,300,RC,,,outpatient,,,56.5,28.25,,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.15,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,51.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,53.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,26.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.78,102.86,
ASPERGILLUS GALACTOMANN AG,1001864,CDM,300,RC,,,outpatient,,,434.75,217.38,,421.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,391.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,391.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,316.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,296.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,350.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,350.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,385.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,288.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.17,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,399.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,413.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,421.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,282.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,391.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.98,391.28,
FUNGITELL B-D-GLUCAN,1001865,CDM,300,RC,,,outpatient,,,231.25,115.63,,224.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,208.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,208.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,168.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,157.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,186.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,186.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,204.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,153.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.17,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,212.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,219.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,224.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,150.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,208.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.98,208.13,
CLOZEPAM,1001866,CDM,300,RC,,,outpatient,,,28.75,14.38,,27.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,102.86,
"HISTOPLASMA ABS, QUANT",1001867,CDM,300,RC,,,outpatient,,,29,14.5,,28.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.83,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.62,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,26.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.79,102.86,
TETANUS ANTITOXOID IGG,1001868,CDM,300,RC,,,outpatient,,,31.75,15.88,,30.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,28.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.24,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,29.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,30.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.99,102.86,
.ACHR BINDING AB (1001869),1001870,CDM,300,RC,,,outpatient,,,548,274,,531.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.35,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,493.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,493.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,398.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,374.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,442.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,442.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,485.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,363.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.84,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,504.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,520.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,531.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,356.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,493.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.4,493.2,
.ACHR BLOCK/MOD AB (1001869),1001871,CDM,300,RC,,,outpatient,,,548,274,,531.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.35,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,493.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,493.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,398.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,374.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,442.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,442.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,485.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,363.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.84,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,504.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,520.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,531.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,356.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,493.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.4,493.2,
VIT B12 UNSAT BINDING CAPACITY,1001872,CDM,300,RC,,,outpatient,,,42.25,21.13,,40.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.33,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,38.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.32,102.86,
.MUSK AB (RFLX CHG 1001873),1001873,CDM,300,RC,,,outpatient,,,1890.25,945.13,,1833.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.35,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1701.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,1701.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,1375.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1290.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,1525.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1525.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1674.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1253.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.84,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,1739.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1795.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,1833.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,1228.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,1701.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.4,1701.23,
"COVID-19, A (BOE-PMH)",1001874,CDM,300,RC,,,outpatient,,,195,97.5,,189.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,58.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,175.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,175.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,141.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,133.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,157.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,157.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,172.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,129.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.27,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,179.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,185.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,189.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,126.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,175.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.31,175.5,
"COVID-19, A (BOE-LC)",1001875,CDM,300,RC,,,outpatient,,,216.5,108.25,,210.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,64.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,194.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,194.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,157.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,147.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,174.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,191.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,143.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.27,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,199.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,205.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,210.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,194.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,51.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.31,194.85,
"HISTOPLASMA AG, URINE (UML)",1001876,CDM,300,RC,,,outpatient,,,202,101,,195.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,181.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,181.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,146.98,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,137.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,163.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,163.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,178.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,133.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.89,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,185.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,191.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,195.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,181.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.25,181.8,
"HISTOPLASMA AB, SERUM (UML)",1001877,CDM,300,RC,,,outpatient,,,202,101,,195.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,181.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,181.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,146.98,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,137.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,163.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,163.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,178.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,133.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.89,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,185.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,191.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,195.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,181.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.25,181.8,
"1,3-BETA-D-GLUCAN, SERUM (UML)",1001878,CDM,300,RC,,,outpatient,,,269,134.5,,260.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,242.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,242.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,195.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,183.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,217.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,217.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,238.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,178.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.17,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,247.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,255.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,260.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,174.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,242.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.98,242.1,
"BLASTOMYCES AB, SERUM (UML)",1001879,CDM,300,RC,,,outpatient,,,80.5,40.25,,78.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.19,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,72.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,58.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,64.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.42,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,74.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,76.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,78.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,72.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.9,102.86,
".COVID-19 IGG AB II, DIRECT ACCESS",1001880,CDM,300,RC,,,outpatient,,,20,10,,19.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6,30,,,percent of total billed charges,Pays at 30% of total billed charges,18,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,56.88,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,18.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,19,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,13,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18,102.86,
CALCITONIN,1001881,CDM,300,RC,,,outpatient,,,56.5,28.25,,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.17,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,51.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,53.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,26.79,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.79,102.86,
BIOFIRE RESPIRATORY-WITH COVID,1001882,CDM,300,RC,,,outpatient,,,1712.5,856.25,,1661.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,416.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,513.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,1541.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1541.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,416.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,1246.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1168.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,416.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,1382.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1382.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1517.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1135.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,562.65,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,1575.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,1626.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,1661.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,1113.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,416.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,416.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,416.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,1541.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,416.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,416.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90,1541.25,
.INSULIN TOTAL (1001885),1001886,CDM,300,RC,,,outpatient,,,31.75,15.88,,30.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,28.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.43,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,29.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,30.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.43,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.43,102.86,
.INSULIN FREE (1001885),1001887,CDM,300,RC,,,outpatient,,,31.75,15.88,,30.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,28.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.48,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,29.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,30.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.95,102.86,
"SARS-CoV-2 SEMI-QNT AB, SPIKE",1001888,CDM,300,RC,,,outpatient,,,88.5,44.25,,85.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,79.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,64.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,71.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,56.88,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,81.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,84.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,79.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.13,102.86,
"ZINC, WHOLE BLOOD",1001889,CDM,300,RC,,,outpatient,,,140.25,70.13,,136.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,126.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,126.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,113.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,124.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.38,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,129.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,133.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,136.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,126.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.39,126.23,
"CRYPTOCOCCUS AG, CSF RFLX",1001890,CDM,300,RC,,,outpatient,,,34,17,,32.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.69,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,31.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,32.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.07,102.86,
"VZV, D PCR (CSF, BLOOD, SWAB)",1001891,CDM,300,RC,,,outpatient,,,436.25,218.13,,423.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,392.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,392.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,317.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,297.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,352.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,352.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,386.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,289.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,401.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,414.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,423.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,283.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,392.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,392.63,
DIHYDROTESTOSTERONE,1001892,CDM,300,RC,,,outpatient,,,143.75,71.88,,139.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,129.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,129.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,104.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,29.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,116.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,39.53,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,132.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,136.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,139.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,29.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,129.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,29.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.28,129.38,
MAG IGM AUTOANTIBODIES,1001893,CDM,300,RC,,,outpatient,,,248,124,,240.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,223.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,223.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,180.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,169.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,200.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,219.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,164.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.31,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,228.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,235.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,240.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,161.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,223.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,223.2,
Detection test for human papillomavirus (hpv),1001896,CDM,300,RC,,,outpatient,,,192.25,96.13,,186.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,173.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,173.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,139.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,131.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,155.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,170.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,127.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,176.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,182.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,186.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,173.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,173.03,
PAP smear,1001897,CDM,300,RC,,,outpatient,,,190.25,95.13,,184.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,171.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,171.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,138.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,129.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,153.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,153.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,168.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,126.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.92,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,175.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,180.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,184.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,123.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,171.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,26.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.61,171.23,
PSA (prostate specific antigen),1001898,CDM,300,RC,,,outpatient,,,85.5,42.75,,82.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.94,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,76.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,69.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.83,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,78.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,82.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,76.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.39,102.86,
PSA (prostate specific antigen) measurement,1001899,CDM,300,RC,,,outpatient,,,39,19.5,,37.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.94,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,35.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.83,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,35.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,37.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.39,102.86,
"CATECHOLAMINES, FRACT, PLASMA",1001900,CDM,300,RC,,,outpatient,,,60.25,30.13,,58.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,43.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,41.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,48.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,53.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,39.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.09,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,55.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,57.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,58.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,25.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.25,102.86,
"CORTISONE, SERUM",1001901,CDM,300,RC,,,outpatient,,,308,154,,298.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.79,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,277.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,277.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,224.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,210.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,248.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,272.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,204.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32.52,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,283.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,292.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,298.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,200.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,277.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,24.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.09,277.2,
.UNSTIM RESPONSE (1001902),1001903,CDM,300,RC,,,outpatient,,,261,130.5,,253.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,234.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,234.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,189.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,178.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,210.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,210.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,231.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,173.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.19,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,240.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,247.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,253.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,169.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,234.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,49.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.03,234.9,
.CANDIDA & TETANUS (1001902),1001904,CDM,300,RC,,,outpatient,,,261,130.5,,253.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,234.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,234.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,189.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,178.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,210.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,210.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,231.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,173.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.19,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,240.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,247.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,253.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,169.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,234.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,49.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.03,234.9,
NORTRIPTYLINE,1001905,CDM,300,RC,,,outpatient,,,27,13.5,,26.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.2,102.86,
"FENTANYL & METABOLITE, SERUM",1001906,CDM,300,RC,,,outpatient,,,233,116.5,,226.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,209.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,139.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,188.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,214.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,221.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,139.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,139.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,209.7,
"ZONISAMIDE, SERUM/PLSMA",1001907,CDM,300,RC,,,outpatient,,,170,85,,164.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,153,90,,,percent of total billed charges,Pays at 90% of total billed charges,153,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,123.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,116.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,137.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,137.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,112.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.89,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,156.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,161.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,164.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,110.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,153,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.25,153,
"MELATONIN, SERUM",1001908,CDM,300,RC,,,outpatient,,,199.5,99.75,,193.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,179.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,179.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,136.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,161.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,176.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,132.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,161.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,183.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,189.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,193.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,129.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,179.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,179.55,
"PREGNENOLONE, MASS SPEC",1001910,CDM,300,RC,,,outpatient,,,61.5,30.75,,59.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,55.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,44.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,41.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,40.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.9,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,56.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,58.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,59.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,55.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,20.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.67,102.86,
ILGF-BINDING PROTEIN 3,1001911,CDM,300,RC,,,outpatient,,,47.75,23.88,,46.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,42.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.31,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,43.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,45.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,46.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,102.86,
PAI-1 4G/5G POLYMORPHISM,1001912,CDM,300,RC,,,outpatient,,,654.25,327.13,,634.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,588.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,588.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,476.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,446.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,528.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,528.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,579.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,433.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.35,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,601.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,621.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,634.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,425.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,63.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,63.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,588.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,63.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,63.96,588.83,
Chemical test of the blood to measure presence or concentration of a substance in the blood,1001913,CDM,300,RC,,,outpatient,,,228.5,114.25,,221.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,205.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,205.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,166.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,155.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,184.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,184.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,202.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,151.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,210.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,217.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,221.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,148.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,205.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,205.65,
Chemical test of the blood to measure presence or concentration of a substance in the blood,1001914,CDM,300,RC,,,outpatient,,,114.25,57.13,,110.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,102.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,102.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,83.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,92.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,75.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,105.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,108.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,110.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,102.86,
INTRINSIC FACTOR BLOCKING ABS,1001915,CDM,300,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.36,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.08,102.86,
Chemical test of the blood to measure presence or concentration of a substance in the blood,1001916,CDM,300,RC,,,outpatient,,,24,12,,23.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,22.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,102.86,
"SARS-COV-2 ABS, NUCLEOCAPSID",1001917,CDM,300,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,56.88,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,42.13,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.13,102.86,
Chemical test of the blood to measure presence or concentration of a substance in the blood,1001918,CDM,300,RC,,,outpatient,,,395.25,197.63,,383.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,355.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,355.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,287.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,269.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,319.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,319.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,350.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,262.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,363.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,375.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,383.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,256.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,355.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,355.73,
ANTI-CENTROMERE ANTIBODY,1001919,CDM,300,RC,,,outpatient,,,172.75,86.38,,167.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,155.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,125.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,117.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,139.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,153.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.27,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,158.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,164.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,167.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,155.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,155.48,
Testing for presence of drug,1001920,CDM,300,RC,,,outpatient,,,129.25,64.63,,125.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,116.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,116.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,94.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,88.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,104.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,104.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,85.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.89,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,118.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,122.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,125.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,116.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,116.33,
CALRETICULIN MUTATION ALYSIS,1001921,CDM,300,RC,,,outpatient,,,997.25,498.63,,967.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,105.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,897.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,897.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,725.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,680.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,121.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,804.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,804.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,883.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,661.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,164.2,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,917.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,947.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,967.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,648.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,121.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,121.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,121.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,897.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,121.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90,897.53,
MPL 515 MUTATION ALYSIS,1001922,CDM,300,RC,,,outpatient,,,1087.75,543.88,,1055.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,150.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,326.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,978.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,978.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,791.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,742.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,150.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,878.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,878.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,963.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,721.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,202.95,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,1000.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,1033.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,1055.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,707.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,150.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,150.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,150.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,978.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,150.33,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90,978.98,
ACETAMINOPHEN,1002012,CDM,300,RC,,,outpatient,,,146.25,73.13,,141.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,43.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,106.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,99.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,118.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,129.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,96.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.16,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,134.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,138.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,141.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.64,131.63,
"KETONES, PLASMA/SERUM",1002016,CDM,300,RC,,,outpatient,,,36.5,18.25,,35.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.08,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.03,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,33.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.17,102.86,
Kidney function panel test,1002021,CDM,300,RC,,,outpatient,,,205.25,102.63,,199.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,184.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,184.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,149.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,140.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,165.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,165.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,181.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,136.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.72,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,188.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,194.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,199.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,133.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,184.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.68,184.73,
ALBUMIN,1002026,CDM,300,RC,,,outpatient,,,23.75,11.88,,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.29,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.68,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,21.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.95,102.86,
ALKALINE PHOSPHATASE,1002036,CDM,300,RC,,,outpatient,,,37,18.5,,35.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.99,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,34.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,102.86,
AMYLASE BODY FLUID,1002044,CDM,300,RC,,,outpatient,,,78.75,39.38,,76.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,70.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,57.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,53.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,63.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.75,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,72.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,74.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,76.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,70.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.48,102.86,
AMYLASE SERUM,1002046,CDM,300,RC,,,outpatient,,,78.75,39.38,,76.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,70.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,57.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,53.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,63.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.75,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,72.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,74.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,76.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,70.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.48,102.86,
AMYLASE URINE 24 HOUR,1002048,CDM,300,RC,,,outpatient,,,81,40.5,,78.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,72.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,58.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,55.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,65.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.75,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,74.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,76.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,78.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,72.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.48,102.86,
AST,1002074,CDM,300,RC,,,outpatient,,,37,18.5,,35.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.99,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,34.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,102.86,
Blood test used to diagnose heart failure,1002075,CDM,300,RC,,,outpatient,,,240.75,120.38,,233.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,216.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,216.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,175.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,164.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,39.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,194.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,194.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,213.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,159.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,53,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,221.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,228.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,233.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,156.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,39.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,39.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,39.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,216.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,39.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,39.26,216.68,
Measurement of direct bilirubin,1002078,CDM,300,RC,,,outpatient,,,81,40.5,,78.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,72.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,58.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,55.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,65.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.78,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,74.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,76.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,78.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,72.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.02,102.86,
BILIRUBIN TOTAL,1002080,CDM,300,RC,,,outpatient,,,31,15.5,,30.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.78,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,28.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.02,102.86,
C REACTIVE PROTEIN HS INFLAMMATION,1002084,CDM,300,RC,,,outpatient,,,106.5,53.25,,103.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,95.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,77.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,72.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,85.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.99,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,97.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,95.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,102.86,
CALCIUM SERUM,1002088,CDM,300,RC,,,outpatient,,,37,18.5,,35.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.16,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.16,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.16,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.97,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,34.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.16,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.16,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.16,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.16,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.16,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.16,102.86,
CALCIUM 24HR URINE,1002090,CDM,300,RC,,,outpatient,,,83.5,41.75,,81,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.23,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,75.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,60.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,67.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,55.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.14,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,76.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,79.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,81,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,75.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.03,102.86,
.CEA - 1000980,1002100,CDM,300,RC,,,outpatient,,,417,208.5,,404.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,375.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,375.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,303.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,284.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,336.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,336.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,369.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,276.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.6,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,383.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,396.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,404.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,271.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,375.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.96,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.96,375.3,
CHLORIDE SERUM,1002104,CDM,300,RC,,,outpatient,,,34,17,,32.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.21,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,31.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,32.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.6,102.86,
CHOLESTEROL-TOT,1002108,CDM,300,RC,,,outpatient,,,55,27.5,,53.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.78,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,49.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,44.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.87,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,50.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,52.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,53.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.35,102.86,
CARBON DIOXIDE,1002112,CDM,300,RC,,,outpatient,,,35.25,17.63,,34.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,31.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.59,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,32.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.88,102.86,
CPK TOTAL,1002126,CDM,300,RC,,,outpatient,,,71.75,35.88,,69.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.64,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,52.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,57.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.79,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,66.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,68.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.51,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.51,102.86,
Blood test to detect heart enzymes,1002128,CDM,300,RC,,,outpatient,,,81.25,40.63,,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,59.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,55.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.59,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,74.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,77.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.55,102.86,
CREATININE CLEAR,1002130,CDM,300,RC,,,outpatient,,,113,56.5,,109.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.2,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,101.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,82.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,91.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.77,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,103.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,107.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,109.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,101.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.46,102.86,
CREATININE W/ GFR,1002133,CDM,300,RC,,,outpatient,,,37,18.5,,35.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.91,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,34.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.12,102.86,
Test to measure creatinine in the urine,1002134,CDM,300,RC,,,outpatient,,,38.25,19.13,,37.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.99,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,35.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,36.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,102.86,
DIGOXIN TOTAL,1002138,CDM,300,RC,,,outpatient,,,146.25,73.13,,141.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,106.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,99.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,118.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,129.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,96.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.93,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,134.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,138.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,141.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.28,131.63,
Blood test to measure a certain protein in the blood to determine heart muscle damage,1002142,CDM,300,RC,,,outpatient,,,95.75,47.88,,92.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,86.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,69.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,65.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,77.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,63.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.83,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,88.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,90.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,92.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,86.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.47,102.86,
Blood test that measures the amount of iron carried in the blood,1002143,CDM,300,RC,,,outpatient,,,37,18.5,,35.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.57,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.8,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,34.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.74,102.86,
Blood test to measure the amount of iron that is in transit in the body,1002144,CDM,300,RC,,,outpatient,,,37,18.5,,35.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.73,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,34.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,102.86,
Blood test to evaluate thyroid function,1002145,CDM,300,RC,,,outpatient,,,33.75,16.88,,32.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.18,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,31.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,32.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.02,102.86,
Test to determine level of iron in the blood,1002146,CDM,300,RC,,,outpatient,,,37,18.5,,35.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.4,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,34.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.63,102.86,
ETHANOL SERUM/PLASMA,1002164,CDM,300,RC,,,outpatient,,,114,57,,110.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,102.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,102.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,75.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,92.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,104.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,108.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,110.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
FOLATE,1002174,CDM,300,RC,,,outpatient,,,152,76,,147.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.75,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,136.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,110.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,103.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,122.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,122.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,100.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.85,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,139.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,144.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,147.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,136.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.7,136.8,
GENTAMICIN PEAK,1002178,CDM,300,RC,,,outpatient,,,192,96,,186.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.2,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,139.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,131.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,154.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,170.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,127.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.11,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,176.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,182.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,186.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.38,172.8,
GENTAMICIN TROUGH,1002179,CDM,300,RC,,,outpatient,,,192,96,,186.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.2,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,139.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,131.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,154.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,170.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,127.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.11,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,176.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,182.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,186.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.38,172.8,
GENTAMICIN RANDOM,1002182,CDM,300,RC,,,outpatient,,,192,96,,186.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.2,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,139.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,131.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,154.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,170.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,127.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.11,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,176.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,182.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,186.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.38,172.8,
GGTP,1002184,CDM,300,RC,,,outpatient,,,67.75,33.88,,65.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,54.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,44.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.72,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,62.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,65.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,7.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.2,102.86,
GLUCOSE BODY FLUID,1002186,CDM,300,RC,,,outpatient,,,42.5,21.25,,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.31,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,39.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.93,102.86,
GLUCOSE CSF,1002188,CDM,300,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.31,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.93,102.86,
Quantitative measure of glucose build up in the blood over time,1002189,CDM,300,RC,,,outpatient,,,42.5,21.25,,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.31,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,39.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.93,102.86,
Quantitative measure of glucose build up in the blood over time,1002190,CDM,300,RC,,,outpatient,,,42.5,21.25,,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.31,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,39.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.93,102.86,
GLUCOSE 24HR URINE,1002192,CDM,300,RC,,,outpatient,,,62,31,,60.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,45.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,42.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.31,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,57.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,58.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,60.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.93,102.86,
Quantitative measure of glucose build up in the blood over time,1002193,CDM,300,RC,,,outpatient,,,42.5,21.25,,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.31,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,39.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.93,102.86,
Blood test to measure average blood glucose levels for past 2-3 months,1002194,CDM,300,RC,,,outpatient,,,79,39.5,,76.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,71.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,57.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,53.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,63.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.11,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,72.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,76.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,71.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.71,102.86,
HCG BETA QUANT,1002204,CDM,300,RC,,,outpatient,,,198.75,99.38,,192.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,178.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,178.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,144.61,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,135.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,160.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,176.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,131.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.32,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,182.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,188.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,192.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,129.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,178.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.05,178.88,
Blood test to measure the level of lipoproteins in the blood,1002206,CDM,300,RC,,,outpatient,,,100.75,50.38,,97.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.1,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,90.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,73.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,68.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,81.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,66.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.06,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,92.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,95.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,97.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.19,102.86,
Test for HIV,1002208,CDM,300,RC,,,outpatient,,,210.5,105.25,,204.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,189.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,189.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,153.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,143.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,169.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,169.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,186.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,139.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32.51,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,193.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,199.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,204.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,136.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,189.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,24.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.08,189.45,
LDH,1002216,CDM,300,RC,,,outpatient,,,54.5,27.25,,52.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.23,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,49.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,39.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,43.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.15,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,50.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,51.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,52.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.04,102.86,
Blood test to determine the concentration of lead in the blood,1002222,CDM,300,RC,,,outpatient,,,119.75,59.88,,116.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,107.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,87.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,81.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,96.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.35,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,110.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,113.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,107.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.11,107.78,
LIPASE,1002228,CDM,300,RC,,,outpatient,,,70.25,35.13,,68.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.97,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,56.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.3,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,64.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,68.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.89,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.89,102.86,
LITHIUM SERUM,1002232,CDM,300,RC,,,outpatient,,,67.75,33.88,,65.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,54.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,44.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.92,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,62.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,65.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.61,102.86,
MAGNESIUM SERUM,1002234,CDM,300,RC,,,outpatient,,,70.5,35.25,,68.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.8,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,63.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,56.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.05,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,64.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,68.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,63.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.7,102.86,
GABAPENTIN LEVEL,1002247,CDM,300,RC,,,outpatient,,,116.25,58.13,,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.9,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,84.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.25,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,106.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,21.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.67,104.63,
PH BODY FLUID,1002252,CDM,300,RC,,,outpatient,,,57.5,28.75,,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.1,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.83,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,52.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,54.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.58,102.86,
PHENYTOIN,1002258,CDM,300,RC,,,outpatient,,,167,83.5,,161.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,150.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,121.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,134.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.89,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,153.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,161.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,150.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.25,150.3,
PHOSPHORUS SERUM,1002260,CDM,300,RC,,,outpatient,,,55.5,27.75,,53.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,49.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,44.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.4,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,51.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,52.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,53.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.74,102.86,
POTASSIUM,1002266,CDM,300,RC,,,outpatient,,,34,17,,32.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.76,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.76,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.76,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.43,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,31.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,32.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.76,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.76,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.76,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.76,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.76,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.76,102.86,
POTASSIUM 24HR URINE,1002268,CDM,300,RC,,,outpatient,,,64,32,,62.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.39,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,58.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,60.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,62.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.73,102.86,
Blood test to assess for pregncy,1002270,CDM,300,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.52,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.15,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,7.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.52,108.45,
.PHENOBARBITAL-1000895,1002272,CDM,300,RC,,,outpatient,,,192.25,96.13,,186.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,173.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,173.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,139.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,131.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,155.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,170.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,127.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.66,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,176.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,182.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,186.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,173.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.3,173.03,
PROTEIN TOTAL BODY FLUID,1002288,CDM,300,RC,,,outpatient,,,57.5,28.75,,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.17,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.4,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,52.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,54.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4,102.86,
PROTEIN TOTAL CSF,1002290,CDM,300,RC,,,outpatient,,,57.5,28.75,,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.17,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.4,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,52.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,54.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4,102.86,
PROTEIN TOTAL SERUM,1002292,CDM,300,RC,,,outpatient,,,26.5,13.25,,25.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.17,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,23.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.95,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,24.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.67,102.86,
PROTEIN 24HR URINE,1002294,CDM,300,RC,,,outpatient,,,57.5,28.75,,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.17,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.95,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,52.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,54.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.67,102.86,
SALICYLATE,1002306,CDM,300,RC,,,outpatient,,,134.5,67.25,,130.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,121.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,97.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,108.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.16,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,123.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,127.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,130.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,121.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.64,121.05,
Blood test to evaluate liver function,1002308,CDM,301,RC,,,outpatient,,,39,19.5,,37.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,35.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.16,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,35.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,37.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.3,102.86,
SODIUM SERUM,1002310,CDM,300,RC,,,outpatient,,,35.25,17.63,,34.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.17,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,31.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.49,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,32.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.81,102.86,
SODIUM 24HR URINE,1002312,CDM,300,RC,,,outpatient,,,55.75,27.88,,54.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,50.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.83,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,51.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,52.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.06,102.86,
VOLUME MEASUREMENT TIMED,1002313,CDM,300,RC,,,outpatient,,,24.25,12.13,,23.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.91,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,22.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.64,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.64,102.86,
PKU COLLECTION FEE,1002315,CDM,300,RC,,,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.55,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,102.86,100,,,Case rate,pays at 100% of fixed rate,,,,,Other,Not Separately reimbursable,100,102.86,
FLUID SPECIFIC GRAVITY,1002316,CDM,300,RC,,,outpatient,,,18.75,9.38,,18.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,16.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.43,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,17.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,,,,,Other,Not Separately reimbursable,3.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.28,102.86,
.TESTOSTERONE FREE-1000830,1002325,CDM,300,RC,,,outpatient,,,235,117.5,,227.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,211.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,211.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,170.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,160.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,189.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,189.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,155.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.38,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,216.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,223.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,227.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,152.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,,,,,Other,Not Separately reimbursable,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,25.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.47,102.86,
.TESTOSTERONE TOTAL-1000830,1002326,CDM,300,RC,,,outpatient,,,216.75,108.38,,210.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,195.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,195.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,157.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,147.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,174.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,192.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,143.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.84,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,199.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,205.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,210.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,,,,,Other,Not Separately reimbursable,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,25.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.81,102.86,
THEOPHYLLINE LEVEL,1002330,CDM,300,RC,,,outpatient,,,163.5,81.75,,158.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.25,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,147.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,147.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,118.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,111.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,131.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,131.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,144.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,108.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.09,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,150.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,155.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,158.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,,,,,Other,Not Separately reimbursable,14.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.14,102.86,
Blood test to measure a type of thyroid hormone,1002336,CDM,300,RC,,,outpatient,,,69.25,34.63,,67.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,62.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,55.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,45.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.27,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,63.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,65.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,67.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,,,,,Other,Not Separately reimbursable,6.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.87,102.86,
TRIGLYCERIDE,1002344,CDM,301,RC,,,outpatient,,,74.5,37.25,,72.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.98,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,67.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,54.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,50.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,60.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,49.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.75,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,68.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,70.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,72.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,,,,,Other,Not Separately reimbursable,5.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.74,102.86,
"Blood test, thyroid stimulating hormone (TSH)",1002347,CDM,300,RC,,,outpatient,,,111.25,55.63,,107.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,80.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,75.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,89.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,73.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.68,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,102.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,105.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,107.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,,,,,Other,Not Separately reimbursable,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.8,102.86,
"Blood test, thyroid stimulating hormone (TSH)",1002348,CDM,300,RC,,,outpatient,,,122.25,61.13,,118.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,110.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,88.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,98.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.68,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,112.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,118.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,,,,,Other,Not Separately reimbursable,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.8,102.86,
BUN,1002350,CDM,300,RC,,,outpatient,,,38.75,19.38,,37.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,34.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.33,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,35.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,36.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,,,,,Other,Not Separately reimbursable,3.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.95,102.86,
UREA 24HR URINE,1002352,CDM,300,RC,,,outpatient,,,57.5,28.75,,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.51,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,52.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,54.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,,,,,Other,Not Separately reimbursable,5.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.56,102.86,
URIC ACID SERUM,1002354,CDM,300,RC,,,outpatient,,,62,31,,60.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,45.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,42.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.1,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,57.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,58.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,60.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.52,102.86,
Blood test to measure B-12,1002364,CDM,300,RC,,,outpatient,,,148.5,74.25,,144.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,133.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,108.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,119.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,131.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.36,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,136.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,133.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.08,133.65,
Blood test to measure average blood glucose levels for past 2-3 months,1002371,CDM,300,RC,,,outpatient,,,19.75,9.88,,19.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,17.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.11,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,18.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.71,102.86,
PSA (prostate specific antigen),1002377,CDM,300,RC,,,outpatient,,,77.75,38.88,,75.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.94,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,69.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,56.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,53.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,51.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.83,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,71.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,73.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,75.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,69.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.39,102.86,
Prostate cancer screening; prostate specific antigen test (psa),1002378,CDM,300,RC,,,outpatient,,,85.5,42.75,,82.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.94,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,76.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,69.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.07,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,78.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,82.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,76.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,,,,,Other,Not Separately reimbursable,19.31,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.31,100,
PSA (prostate specific antigen),1002379,CDM,300,RC,,,outpatient,,,85.5,42.75,,82.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.94,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,76.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,69.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.83,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,78.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,82.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,76.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.39,102.86,
VANCOMYCIN RANDOM,1002388,CDM,300,RC,,,outpatient,,,139.5,69.75,,135.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,101.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,112.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.28,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,128.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,135.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.54,125.55,
VANCOMYCIN TROUGH,1002396,CDM,300,RC,,,outpatient,,,139.5,69.75,,135.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,101.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,112.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.28,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,128.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,135.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.54,125.55,
VANCOMYCIN PEAK,1002399,CDM,300,RC,,,outpatient,,,139.5,69.75,,135.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,101.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,112.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.28,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,128.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,135.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.54,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.54,125.55,
Blood test to evaluate thyroid function,1002408,CDM,300,RC,,,outpatient,,,37,18.5,,35.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.18,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,34.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.02,102.86,
FINGERSTICK NURSE COLLECT,1002417,CDM,300,RC,,,outpatient,,,,,,,,,,other,Not Separately reimbursable,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,6.8,135,,,fee schedule,Pays at 135% of Medicare OPPS rate, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,,,,,Other,Not Separately reimbursable,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.04,102.86,
GLUCOSE WHOLE BLOOD LAB FINGERSTICK,1002418,CDM,300,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.8,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.04,102.86,
LACTIC ACID,1002428,CDM,300,RC,,,outpatient,,,92,46,,89.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,82.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,66.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,62.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,74.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.62,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,84.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,82.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.57,102.86,
Test for RSV,1002452,CDM,300,RC,,,outpatient,,,188.5,94.25,,182.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,169.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,169.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,137.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,128.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,152.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,167.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,124.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.69,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,173.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,179.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,182.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,122.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,169.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.1,169.65,
Blood test to measure level of prealbumin,1002492,CDM,300,RC,,,outpatient,,,97,48.5,,94.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.64,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,70.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,66.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,78.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,64.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.7,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,89.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,92.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,94.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.59,102.86,
Automated urilysis test,1002539,CDM,300,RC,,,outpatient,,,34.5,17.25,,33.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,1.94,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.04,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,31.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,32.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.25,102.86,
"Complete blood cell count, with differential white blood cells, automated",1002540,CDM,300,RC,,,outpatient,,,79.5,39.75,,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,57.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.49,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,73.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,7.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.77,102.86,
"Complete blood count, automated",1002541,CDM,300,RC,,,outpatient,,,52.5,26.25,,50.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.6,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,35.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.73,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,48.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,49.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,50.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,102.86,
Blood test to assess for infection,1002542,CDM,300,RC,,,outpatient,,,36,18,,34.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.98,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,32.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.13,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,33.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.8,102.86,
"Complete blood cell count, with differential white blood cells, automated",1002543,CDM,300,RC,,,outpatient,,,,,,,,,,other,Not Separately reimbursable,7.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,7.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,10.49,135,,,fee schedule,Pays at 135% of Medicare OPPS rate, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,7.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,,,,,Other,Not Separately reimbursable,7.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,7.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.77,102.86,
Manual urilysis test with examition with or without using microscope,1002546,CDM,300,RC,,,outpatient,,,69.75,34.88,,67.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.75,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,62.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,56.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.28,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,64.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,67.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.17,102.86,
Blood test to monitor vitamin D levels,1002576,CDM,300,RC,,,outpatient,,,183.5,91.75,,178,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.65,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,165.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,133.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,125.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,148.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,39.96,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,168.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,174.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,178,97,,,percent of total billed charges,Pays at 97% of total billed charges,119.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,165.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.6,165.15,
DDIMER,1002582,CDM,300,RC,,,outpatient,,,102,51,,98.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,91.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,74.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,82.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.74,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,93.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,91.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.18,102.86,
.CA 19-9 - 1000980,1002668,CDM,300,RC,,,outpatient,,,417,208.5,,404.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.04,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,375.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,375.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,303.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,284.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,336.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,336.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,369.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,276.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.09,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,383.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,396.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,404.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,271.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,375.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.81,375.3,
Blood test to if peptic ulcers are caused by a certain bacterium,1002704,CDM,300,RC,,,outpatient,,,52.75,26.38,,51.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.14,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.75,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,48.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.85,102.86,
Blood test to if peptic ulcers are caused by a certain bacterium,1002707,CDM,300,RC,,,outpatient,,,52.75,26.38,,51.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.14,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.75,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,48.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.85,102.86,
FLUOXETINE (PROZAC),1002708,CDM,300,RC,,,outpatient,,,112.75,56.38,,109.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,101.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,103.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,107.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,109.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Blood test to if peptic ulcers are caused by a certain bacterium,1002709,CDM,300,RC,,,outpatient,,,52.75,26.38,,51.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.14,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.75,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,48.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.85,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.85,102.86,
Manual urilysis test with examition without using microscope,1002762,CDM,300,RC,,,outpatient,,,34.75,17.38,,33.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.71,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.7,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,31.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.48,102.86,
ALLERGEN IGG SINGLE,1002763,CDM,300,RC,,,outpatient,,,60.25,30.13,,58.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.1,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,43.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,41.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,48.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,53.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,39.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.56,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,55.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,57.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,58.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,7.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.82,102.86,
ALLERGEN IGE SINGLE,1002764,CDM,300,RC,,,outpatient,,,30.5,15.25,,29.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.52,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,27.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.05,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,28.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,102.86,
GAMMAGLOBULIN; IgE - 01002768 PROFILE,1002767,CDM,300,RC,,,outpatient,,,24.75,12.38,,24.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.22,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,22.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.46,102.86,
.ALLERGEN IGE SINGLE X 26 - 01002768,1002769,CDM,300,RC,,,outpatient,,,238.25,119.13,,231.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.52,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,214.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,214.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,173.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,162.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,192.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,192.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,211.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,157.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.05,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,219.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,226.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,231.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,154.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,214.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.22,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.22,214.43,
Blood test to determine cause of ippropriate blood clot formation,1002797,CDM,300,RC,,,outpatient,,,38.75,19.38,,37.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,34.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.36,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,35.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,36.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,102.86,
Blood test to determine cause of ippropriate blood clot formation,1002798,CDM,300,RC,,,outpatient,,,77.25,38.63,,74.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,69.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,56.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,51.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.36,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,71.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,73.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,69.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,102.86,
.IFE - 1000850 & 1000855,1002839,CDM,300,RC,,,outpatient,,,61.25,30.63,,59.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.34,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,55.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.34,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,44.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,41.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.34,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,40.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.16,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,56.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,58.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,59.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.34,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.34,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.34,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,55.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.34,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,22.34,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.34,102.86,
GASTROCCULT,1002860,CDM,300,RC,,,outpatient,,,24.25,12.13,,23.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.23,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.06,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,22.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.71,102.86,
General health panel,1002862,CDM,300,RC,,,outpatient,,,122.5,61.25,,118.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,110.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,99.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,118.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,73.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,110.25,
Blood test to measure levels of hemoglobin,1002865,CDM,300,RC,,,outpatient,,,18.5,9.25,,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.2,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,17.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.37,102.86,
Liver function blood test panel,1002869,CDM,300,RC,,,outpatient,,,158.25,79.13,,153.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.08,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,142.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,115.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,108.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,127.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,140.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.03,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,145.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,150.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,153.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,142.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.17,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.17,142.43,
FLOW CYTOMETRY /EACH ADD,1002879,CDM,311,RC,,,outpatient,,,92.5,46.25,,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,74.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,102.86,
PLATELET COUNT ONLY,1002910,CDM,300,RC,,,outpatient,,,26.5,13.25,,25.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,23.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.05,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,24.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.48,102.86,
T3 FREE,1002919,CDM,300,RC,,,outpatient,,,248.5,124.25,,241.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.68,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,223.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,223.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,180.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,169.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,200.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,220.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,164.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.87,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,228.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,236.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,241.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,161.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,223.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.94,223.65,
FUNGAL OR YEAST ID,1002930,CDM,300,RC,,,outpatient,,,112,56,,108.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,81.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.93,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,103.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,100.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,10.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.32,102.86,
FUNGAL OR YEAST SENS <12,1002932,CDM,300,RC,,,outpatient,,,50,25,,48.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.97,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,45,90,,,percent of total billed charges,Pays at 90% of total billed charges,45,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.1,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,46,92,,,percent of total billed charges,Pays at 92% of total billed charges,47.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,48.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,45,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,7.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.48,102.86,
URINE DRUG SCREEN ER 13 DRUGS,1002957,CDM,300,RC,,,outpatient,,,361.25,180.63,,350.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,325.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,325.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,262.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,246.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,291.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,291.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,320.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,239.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.14,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,332.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,343.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,350.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,234.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,325.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.14,325.13,
BB TRANSFUSION INVESTIGATE,1002958,CDM,300,RC,,,outpatient,,,217.5,108.75,,210.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,130.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,195.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,195.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,148.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,130.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,175.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,175.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,192.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,144.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,176.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,200.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,206.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,210.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,141.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,130.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,130.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,195.75,
. TEST URINE DRUG SCREEN ER 13 DRUGS,1002959,CDM,300,RC,,,outpatient,,,361.25,180.63,,350.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,325.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,325.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,262.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,246.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,291.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,291.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,320.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,239.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.14,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,332.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,343.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,350.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,234.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,325.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.14,325.13,
BB ANTIGEN TYPING (PATIENT),1002960,CDM,300,RC,,,outpatient,,,101.5,50.75,,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.83,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.32,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.83,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,73.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.83,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.17,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,93.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.83,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.83,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.83,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.83,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.83,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.83,102.86,
BB FFP THAWING,1002962,CDM,300,RC,,,outpatient,,,312.75,156.38,,303.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,187.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,281.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,281.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,213.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,187.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,252.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,277.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,207.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,253.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,287.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,297.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,303.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,203.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,187.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,281.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,187.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,281.48,
BB AUTOLOGOUS BLOOD,1002964,CDM,390,RC,,,outpatient,,,795,397.5,,771.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,477,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.14,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,715.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,715.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,477,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,578.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,542.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,477,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,641.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,641.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,704.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,527.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,643.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,731.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,755.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,771.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,516.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,477,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,477,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,477,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,715.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,477,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,477,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,715.5,
BB DIRECTED DONOR RBC'S,1002966,CDM,390,RC,,,outpatient,,,795,397.5,,771.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,477,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,348.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,715.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,715.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,477,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,578.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,542.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,477,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,641.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,641.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,704.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,527.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,643.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,731.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,755.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,771.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,516.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,477,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,477,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,477,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,715.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,477,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,477,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,715.5,
.BB ABO TYPE,1002968,CDM,300,RC,,,outpatient,,,42.75,21.38,,41.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.04,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,39.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.99,102.86,
.BB RH TYPE,1002970,CDM,300,RC,,,outpatient,,,42.75,21.38,,41.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.04,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,39.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,2.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.99,102.86,
BB RHOGAM,1002980,CDM,250,RC,,,outpatient,,,197,98.5,,191.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,177.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,177.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,134.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,118.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,159.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,130.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,159.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,181.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,187.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,191.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,128.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,118.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,118.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,177.3,
BB ANTIBODY ID EACH CELL,1003004,CDM,300,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.72,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.72,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.72,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.72,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.72,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.72,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.72,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.72,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.72,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.72,102.86,
BB ANTIBODY ID PANEL,1003006,CDM,300,RC,,,outpatient,,,187.5,93.75,,181.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,168.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,127.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,151.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,166.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,124.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,151.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,172.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,178.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,181.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,168.75,
BB ANTIGEN TYPING/UNIT,1003010,CDM,300,RC,,,outpatient,,,64.5,32.25,,62.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,52.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,59.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,62.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,58.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.35,102.86,
BB LEUKOREDUCED RBC,1003016,CDM,390,RC,,,outpatient,,,486.5,243.25,,471.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,291.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,348.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,437.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,437.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,291.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,353.98,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,332.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,291.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,392.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,392.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,431.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,322.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,394.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,447.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,462.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,471.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,316.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,291.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,291.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,291.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,437.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,291.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,291.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,437.85,
BB BLOOD IRR CMV NEG EA UNIT,1003017,CDM,390,RC,,,outpatient,,,831.75,415.88,,806.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,499.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,748.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,748.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,499.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,605.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,567.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,499.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,671.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,671.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,737.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,551.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,673.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,765.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,790.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,806.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,540.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,499.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,499.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,499.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,748.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,499.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,499.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,748.58,
BB PLATELETS PER UNIT,1003019,CDM,390,RC,,,outpatient,,,192,96,,186.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,175.28,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,131.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,170.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,127.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,155.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,176.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,182.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,186.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,172.8,
BB PLATELETS PHERESIS EACH,1003020,CDM,390,RC,,,outpatient,,,1309,654.5,,1269.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,785.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,798.38,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1178.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,1178.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,785.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,952.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,893.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,785.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1056.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1056.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1159.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,867.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1060.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1204.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,1243.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,1269.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,850.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,785.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,785.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,785.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1178.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,785.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,785.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1178.1,
BB PLT IRR CMV NEG EA UNIT,1003022,CDM,390,RC,,,outpatient,,,1434.75,717.38,,1391.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,860.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,594.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1291.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1291.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,860.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1043.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,979.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,860.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1158.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1158.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1271.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,951.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1162.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1319.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,1363.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,1391.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,932.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,860.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,860.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,860.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1291.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,860.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,860.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1291.28,
"PARATHYROID HORMONE, INTACT",1003023,CDM,300,RC,,,outpatient,,,256.5,128.25,,248.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.77,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,230.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,230.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,186.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,175.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,41.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,207.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,207.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,227.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,170.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,55.73,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,235.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,243.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,248.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,166.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,41.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,230.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,41.28,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.28,230.85,
THERAPEUTIC PHLEBOTOMY,1003030,CDM,940,RC,,,outpatient,,,86,43,,83.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.5,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,77.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,57.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,79.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,51.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.6,102.86,
BB ELUTION FOR POSITIVE DAT,1003038,CDM,300,RC,,,outpatient,,,161,80.5,,156.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,144.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,144.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,109.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,129.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,106.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,130.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,148.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,152.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,156.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,144.9,
BB ANTIBODY TITER,1003042,CDM,300,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.99,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,134.1,
BB IRRADIATION OF BLOOD,1003046,CDM,390,RC,,,outpatient,,,282,141,,273.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,253.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,253.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,192.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,227.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,249.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,186.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,228.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,259.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,267.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,273.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,183.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,253.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,253.8,
"Blood test, comprehensive group of blood chemicals",1003049,CDM,300,RC,,,outpatient,,,208.75,104.38,,202.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.16,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,187.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,151.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,142.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,168.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,168.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,184.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,138.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.26,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,192.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,198.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,202.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,187.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,10.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.56,187.88,
Test to measure arterial blood gases,1003302,CDM,300,RC,,,outpatient,,,286.25,143.13,,277.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,257.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,257.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,208.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,195.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,231.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,231.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,253.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,189.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.19,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,263.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,271.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,277.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,186.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,257.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,26.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.07,257.63,
.CARBOXY HEMOGLOBIN,1003304,CDM,300,RC,,,outpatient,,,92.25,46.13,,89.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.68,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,83.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,67.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,62.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,74.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.63,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,84.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,83.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.32,102.86,
.METHEMOGLOBIN,1003306,CDM,300,RC,,,outpatient,,,82.75,41.38,,80.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,60.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,66.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.07,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,76.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.2,102.86,
Blood test to measure levels of hemoglobin,1003308,CDM,300,RC,,,outpatient,,,26,13,,25.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,23.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.2,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,23.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.37,102.86,
PH UMBILICAL VEIN,1003310,CDM,300,RC,,,outpatient,,,123.75,61.88,,120.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.58,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,111.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,84.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,99.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,109.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,82.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.85,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,113.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,117.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,120.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,111.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11,111.38,
Test to measure arterial blood gases,1003312,CDM,300,RC,,,outpatient,,,286.25,143.13,,277.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,257.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,257.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,208.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,195.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,231.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,231.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,253.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,189.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.19,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,263.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,271.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,277.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,186.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,257.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,26.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.07,257.63,
VENOUS PH,1003420,CDM,300,RC,,,outpatient,,,123.75,61.88,,120.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.58,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,111.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,84.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,99.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,109.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,82.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.85,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,113.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,117.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,120.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,111.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11,111.38,
.B2 GLYCOPROTEIN IGG-1000809,1003451,CDM,300,RC,,,outpatient,,,12.25,6.13,,11.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.36,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,11.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.03,102.86,
.B2 GLYCOPROTEIN IGA/IGM-1000809,1003452,CDM,300,RC,,,outpatient,,,24.25,12.13,,23.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.36,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,22.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.83,102.86,
Test that detects Chlamydia,1003691,CDM,300,RC,,,outpatient,,,131.75,65.88,,127.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,118.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,95.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,106.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,121.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,125.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,127.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,118.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,118.58,
Blood test for an STD,1003692,CDM,300,RC,,,outpatient,,,131.75,65.88,,127.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,118.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,95.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,106.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,121.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,125.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,127.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,118.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,118.58,
Blood test for an STD,1003693,CDM,300,RC,,,outpatient,,,131.75,65.88,,127.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,118.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,95.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,106.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,121.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,125.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,127.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,118.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,118.58,
Blood test to determine genetic material of certain infectious agents,1003694,CDM,300,RC,,,outpatient,,,131.75,65.88,,127.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,60.83,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,118.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,95.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,70.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,106.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.77,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,121.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,125.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,127.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,70.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,70.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,70.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,118.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,70.2,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,70.2,118.58,
.ATOPOBIUM VAG (1003690),1003695,CDM,300,RC,,,outpatient,,,131.75,65.88,,127.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,118.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,95.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,106.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,121.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,125.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,127.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,118.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,118.58,
.BVAB2&MEGASPHAERA (1003690),1003696,CDM,300,RC,,,outpatient,,,263.75,131.88,,255.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,237.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,237.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,191.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,180.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,212.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,212.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,233.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,174.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,242.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,250.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,255.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,171.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,237.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,237.38,
Test that detects Chlamydia,1003701,CDM,300,RC,,,outpatient,,,42.25,21.13,,40.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,38.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,102.86,
Blood test for an STD,1003702,CDM,300,RC,,,outpatient,,,42.25,21.13,,40.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,38.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,102.86,
Chemical test of the blood to measure presence or concentration of a substance in the blood,1003706,CDM,300,RC,,,outpatient,,,144.5,72.25,,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,105.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,132.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,130.05,
Chemical test of the blood to measure presence or concentration of a substance in the blood,1003707,CDM,300,RC,,,outpatient,,,288.75,144.38,,280.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,259.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,259.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,210.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,197.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,233.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,233.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,255.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,191.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,265.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,274.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,280.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,187.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,259.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.53,259.88,
.gASCA (1003705),1003708,CDM,300,RC,,,outpatient,,,144.5,72.25,,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,105.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.27,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,132.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,130.05,
.pANCA (1003705),1003709,CDM,300,RC,,,outpatient,,,144.5,72.25,,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,105.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.54,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,132.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.25,130.05,
.ANTI-RNP (1003710),1003711,CDM,300,RC,,,outpatient,,,24.5,12.25,,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.55,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.21,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,22.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,102.86,
.ANTI-SMITH (1003710),1003712,CDM,300,RC,,,outpatient,,,24.5,12.25,,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.55,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.21,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,22.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,102.86,
LKM ANTIBODIES,1003715,CDM,300,RC,,,outpatient,,,39.5,19.75,,38.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.64,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,36.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,37.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,38.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.55,102.86,
"MTHFR, D ALYSIS",1003716,CDM,310,RC,,,outpatient,,,222.75,111.38,,216.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.34,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.97,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,200.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.34,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,162.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,152.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,65.34,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,179.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,179.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,197.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,147.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,,,,,Other,Not Separately reimbursable,204.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,211.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,216.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,144.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,65.34,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,65.34,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,65.34,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,200.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.34,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,65.34,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,65.34,200.48,
"CATECHOLAMINES, FREE, 24H U",1003717,CDM,300,RC,,,outpatient,,,60.25,30.13,,58.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,43.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,41.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,48.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,53.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,39.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.09,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,55.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,57.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,58.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,25.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.25,102.86,
"VMA, 24H URINE",1003718,CDM,300,RC,,,outpatient,,,60.25,30.13,,58.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,43.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,41.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,48.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,53.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,39.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.93,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,55.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,57.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,58.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.5,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.5,102.86,
"METANEPHRINE, PLASMA FREE, FRACTIOTE",1003719,CDM,300,RC,,,outpatient,,,104.5,52.25,,101.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.68,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,94.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,76.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,71.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,84.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,69.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.87,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,96.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,99.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,101.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,94.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.94,102.86,
Testing for presence of drug,1003720,CDM,300,RC,,,outpatient,,,89.75,44.88,,87.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,80.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,65.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,72.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.89,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,82.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,85.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,87.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,80.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,102.86,
Coagulation assessment blood test,1003726,CDM,300,RC,,,outpatient,,,350.5,175.25,,339.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.2,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,315.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,315.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,255.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,239.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,282.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,282.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,310.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,232.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.11,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,322.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,332.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,339.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,227.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,315.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.01,315.45,
.FACTOR VIII ACTIVITY (1003725),1003727,CDM,300,RC,,,outpatient,,,350.5,175.25,,339.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,315.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,315.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,255.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,239.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,282.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,282.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,310.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,232.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.17,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,322.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,332.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,339.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,227.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,315.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.9,315.45,
.VWF ACTIVITY (1003725),1003728,CDM,300,RC,,,outpatient,,,350.5,175.25,,339.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,315.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,315.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,255.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,239.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,282.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,282.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,310.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,232.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.97,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,322.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,332.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,339.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,227.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,315.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,22.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.94,315.45,
.VWF ANTIGEN (1003725),1003729,CDM,300,RC,,,outpatient,,,350.5,175.25,,339.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,315.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,315.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,255.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,239.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,282.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,282.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,310.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,232.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.97,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,322.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,332.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,339.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,227.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,315.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,22.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.94,315.45,
.VWF COLLAGEN BINDING (1003725),1003730,CDM,300,RC,,,outpatient,,,350.5,175.25,,339.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,315.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,315.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,255.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,239.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,282.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,282.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,310.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,232.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.31,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,322.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,332.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,339.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,227.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,315.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,315.45,
Urine pregncy test,1003852,CDM,300,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.62,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.61,102.86,
BB DIRECT COOMBS C3,1003853,CDM,300,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.67,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.28,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.39,102.86,
BB DIRECT COOMBS IGG,1003854,CDM,300,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.67,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.28,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.39,102.86,
"KOH PREP, SKIN, HAIR, ILS",1003860,CDM,300,RC,,,outpatient,,,42.5,21.25,,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.71,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.76,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,39.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,102.86,
AMYLASE URINE,1003861,CDM,300,RC,,,outpatient,,,78.75,39.38,,76.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,70.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,57.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,53.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,63.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.75,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,72.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,74.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,76.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,70.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.48,102.86,
CALCIUM URINE,1003862,CDM,300,RC,,,outpatient,,,83.5,41.75,,81,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.23,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,75.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,60.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,67.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,55.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.14,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,76.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,79.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,81,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,75.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.03,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.03,102.86,
Test to measure creatinine in the urine,1003863,CDM,300,RC,,,outpatient,,,38.25,19.13,,37.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.99,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,35.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,36.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,102.86,
GLUCOSE URINE,1003866,CDM,300,RC,,,outpatient,,,62,31,,60.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,45.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,42.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.31,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,57.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,58.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,60.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.93,102.86,
POTASSIUM URINE,1003871,CDM,300,RC,,,outpatient,,,64,32,,62.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.39,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,58.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,60.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,62.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.73,102.86,
PROTEIN URINE,1003872,CDM,300,RC,,,outpatient,,,57.5,28.75,,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.17,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.95,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,52.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,54.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.67,102.86,
SODIUM URINE,1003873,CDM,300,RC,,,outpatient,,,55.75,27.88,,54.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,50.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.83,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,51.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,52.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.06,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.06,102.86,
UREA URINE,1003874,CDM,300,RC,,,outpatient,,,57.5,28.75,,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.51,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,52.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,54.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.56,102.86,
CSF CELL COUNT W/DIFF,1003876,CDM,300,RC,,,outpatient,,,101,50.5,,97.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.77,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,90.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,73.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,68.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,81.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,66.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.56,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,92.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,95.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,97.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.6,102.86,
Test of body fluid other than blood to assess for bacteria,1003877,CDM,300,RC,,,outpatient,,,131,65.5,,127.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,117.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,95.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,105.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.64,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,120.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,124.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,127.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,117.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.62,117.9,
OCCULT BLOOD  1 TO 3 DETERMITION,1003878,CDM,300,RC,,,outpatient,,,25.75,12.88,,24.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.78,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,23.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.49,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,23.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.92,102.86,
SEMEN ALYSIS POST VAS,1004014,CDM,300,RC,,,outpatient,,,37.75,18.88,,36.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,33.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.27,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,34.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,36.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,102.86,
Manual urilysis test with examition without using microscope,1004017,CDM,300,RC,,,outpatient,,,20.25,10.13,,19.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.71,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.7,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,18.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.48,102.86,
Automated urilysis test,1004018,CDM,300,RC,,,outpatient,,,34.75,17.38,,33.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,1.94,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.04,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,31.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.25,102.86,
URILYSIS MICROSCOPIC ONLY,1004019,CDM,300,RC,,,outpatient,,,38.75,19.38,,37.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.64,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,34.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.12,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,35.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,36.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.05,102.86,
A lab test used to detect bacteria or fungi in a sample taken from the site of a suspected infection,1004020,CDM,300,RC,,,outpatient,,,43.25,21.63,,41.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.71,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,38.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.76,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,39.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,102.86,
FACTOR VIII ASSAY,1004029,CDM,300,RC,,,outpatient,,,239.5,119.75,,232.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,215.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,215.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,174.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,163.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,193.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,193.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,212.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,158.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.17,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,220.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,227.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,232.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,215.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.9,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.9,215.55,
Urine test to measure albumin,1004070,CDM,300,RC,,,outpatient,,,71.75,35.88,,69.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,52.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,57.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.8,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,66.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,68.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.78,102.86,
Urine test to measure albumin,1004072,CDM,300,RC,,,outpatient,,,71.75,35.88,,69.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,52.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,57.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.8,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,66.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,68.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.78,102.86,
Urine test to measure albumin,1004074,CDM,300,RC,,,outpatient,,,14,7,,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.8,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,12.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.78,102.86,
BB TRANSFUSION CHARGE,1004253,CDM,391,RC,,,outpatient,,,360,180,,349.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,216,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.28,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,324,90,,,percent of total billed charges,Pays at 90% of total billed charges,324,90,,,percent of total billed charges,Pays at 90% of total billed charges,216,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,261.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,245.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,216,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,290.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,290.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,319,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,238.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,291.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,331.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,342,95,,,percent of total billed charges,Pays at 95% of total billed charges,349.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,234,65,,,percent of total billed charges,Pays at 65% of total billed charges,216,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,216,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,216,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,324,90,,,percent of total billed charges,Pays at 90% of total billed charges,216,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,216,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,324,
".RESPIRATORY, PCR (1004400)",1004401,CDM,306,RC,,,outpatient,,,1239,619.5,,1201.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,416.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,361.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1115.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,1115.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,416.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,901.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,845.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,416.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,1000.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1000.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1097.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,821.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,562.65,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,1139.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,1177.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,1201.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,805.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,416.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,416.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,416.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,1115.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,416.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,416.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90,1115.1,
".BORDETELLA, PCR (1004400)",1004402,CDM,306,RC,,,outpatient,,,105,52.5,,101.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,94.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,76.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,71.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,84.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,69.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,96.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,99.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,101.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,94.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,102.86,
".CHLAMYDOPHILIA, PCR (1004400)",1004403,CDM,306,RC,,,outpatient,,,105,52.5,,101.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,94.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,76.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,71.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,84.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,69.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,96.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,99.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,101.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,94.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,102.86,
".MYCOPLASMA, PCR (1004400)",1004404,CDM,306,RC,,,outpatient,,,105,52.5,,101.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,94.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,76.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,71.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,84.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,69.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,96.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,99.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,101.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,94.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,102.86,
"BIOFIRE, GASTROINTESTIL PANEL",1004405,CDM,300,RC,,,outpatient,,,1239,619.5,,1201.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,416.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,361.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1115.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,1115.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,416.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,901.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,845.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,416.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,1000.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1000.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1097.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,821.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,562.65,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,1139.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,1177.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,1201.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,805.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,416.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,416.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,416.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,1115.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,416.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,416.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90,1115.1,
.BLOOD CX ID (1004410),1004411,CDM,300,RC,,,outpatient,,,105,52.5,,101.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,94.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,76.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,71.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,84.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,69.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,96.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,99.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,101.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,94.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,102.86,
.BLOOD CX ID ADDITIOL (1004410),1004412,CDM,300,RC,,,outpatient,,,2401.25,1200.63,,2329.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2161.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,2161.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,1747.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1638.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,1938.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1938.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2127.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1592.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,2209.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,2281.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,2329.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,1560.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2161.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,2161.13,
NMR LIPOPROTEIN,1004654,CDM,300,RC,,,outpatient,,,88.5,44.25,,85.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.35,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,79.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,64.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,34.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,71.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,46.16,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,81.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,84.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,34.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,79.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,34.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.19,102.86,
".CONCENTRATION, ACID FAST (1000637)",1005003,CDM,300,RC,,,outpatient,,,25.25,12.63,,24.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.79,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.02,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,23.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.68,102.86,
.SMEAR ACID FAST (1000637),1005004,CDM,300,RC,,,outpatient,,,43.5,21.75,,42.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.67,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.28,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,40.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,39.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.39,102.86,
A test used to determine which medications work on bacteria for fungi,1005010,CDM,300,RC,,,outpatient,,,68.25,34.13,,66.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.5,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,55.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,45.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.68,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,62.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,66.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.65,102.86,
Test of a wound for type of bacterial infection,1005011,CDM,300,RC,,,outpatient,,,58.5,29.25,,56.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,52.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,47.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.91,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,53.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,55.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,56.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,52.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.08,102.86,
Blood test to screen for bacteria in the blood,1005012,CDM,300,RC,,,outpatient,,,198.75,99.38,,192.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,178.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,178.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,144.61,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,135.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,160.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,176.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,131.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.93,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,182.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,188.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,192.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,129.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,178.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,10.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.32,178.88,
Test of body fluid other than blood to assess for bacteria,1005014,CDM,300,RC,,,outpatient,,,102,51,,98.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,91.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,74.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,82.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.64,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,93.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,91.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.62,102.86,
BACTERIAL ID AEROBIC,1005015,CDM,300,RC,,,outpatient,,,35.25,17.63,,34.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,31.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.91,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,32.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.08,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.08,102.86,
A test used to determine which medications work on bacteria for fungi,1005019,CDM,300,RC,,,outpatient,,,68,34,,65.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.5,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,61.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,54.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,45.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.68,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,62.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,65.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,61.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.65,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.65,102.86,
Test of body fluid other than blood to assess for bacteria,1005020,CDM,300,RC,,,outpatient,,,143.25,71.63,,138.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,128.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,104.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,97.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,115.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,94.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.64,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,131.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,136.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,138.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,128.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.62,128.93,
CULTURE AEROBIC,1005021,CDM,300,RC,,,outpatient,,,134.25,67.13,,130.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,120.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,97.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,108.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.78,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,123.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,127.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,130.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,120.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.47,120.83,
CULTURE STOOL,1005024,CDM,300,RC,,,outpatient,,,121.75,60.88,,118.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.18,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,88.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,98.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.74,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,112.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,115.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,118.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.44,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.44,109.58,
CULTURE FUNGAL OTHER,1005026,CDM,300,RC,,,outpatient,,,101,50.5,,97.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.29,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,90.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,73.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,68.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,81.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,66.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.35,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,92.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,95.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,97.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.41,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.41,102.86,
Medical test to find an infection,1005028,CDM,300,RC,,,outpatient,,,92,46,,89.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,82.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,66.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,62.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,74.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.95,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,84.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,82.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.63,102.86,
Test of body fluid other than blood to assess for bacteria,1005030,CDM,300,RC,,,outpatient,,,92,46,,89.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,82.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,66.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,62.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,74.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.64,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,84.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,82.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.62,102.86,
A lab test used to detect bacteria or fungi in a sample taken from the site of a suspected infection,1005032,CDM,300,RC,,,outpatient,,,26.5,13.25,,25.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.71,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,23.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.76,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,24.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,102.86,
"STREP GRP A, A",1005036,CDM,300,RC,,,outpatient,,,73.75,36.88,,71.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,66.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,66.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,53.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,50.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,59.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,59.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,48.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,67.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,70.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,71.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,66.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,102.86,
Test of body fluid other than blood to assess for bacteria,1005038,CDM,300,RC,,,outpatient,,,87.5,43.75,,84.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,63.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,70.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.64,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,80.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,84.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,78.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.62,102.86,
Medical test to find an infection,1005039,CDM,300,RC,,,outpatient,,,69.5,34.75,,67.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,56.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.95,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,63.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,67.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.63,102.86,
Medical test to find an infection,1005040,CDM,300,RC,,,outpatient,,,56.25,28.13,,54.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,50.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,45.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.95,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,51.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,53.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.63,102.86,
Culture of the urine to determine number of bacteria,1005042,CDM,300,RC,,,outpatient,,,87.25,43.63,,84.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,63.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,70.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,57.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.89,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,80.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,82.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,84.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,78.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.07,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.07,102.86,
A lab test to screen for evidence of vagil infection,1005044,CDM,300,RC,,,outpatient,,,34.75,17.38,,33.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.86,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,31.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.82,102.86,
Test of body fluid other than blood to assess for bacteria,1005046,CDM,300,RC,,,outpatient,,,131,65.5,,127.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,117.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,95.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,105.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.64,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,120.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,124.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,127.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,117.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.62,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.62,117.9,
A test of the stool to diagnose Clostridium difficile (C. diff) infection,1005048,CDM,300,RC,,,outpatient,,,140.25,70.13,,136.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,126.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,126.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,113.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,124.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.17,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,129.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,133.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,136.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,126.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.98,126.23,
Medical test to find an infection,1005084,CDM,300,RC,,,outpatient,,,69.5,34.75,,67.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,56.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.95,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,63.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,67.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.63,102.86,
Medical test to find an infection,1005085,CDM,300,RC,,,outpatient,,,69.5,34.75,,67.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,56.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.95,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,63.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,67.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.63,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.63,102.86,
".FUNGI ID, MOLD (UML - NON-INTERFACED)",1005100,CDM,300,RC,,,outpatient,,,26.75,13.38,,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.93,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,24.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,10.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.32,102.86,
PORT DRAW SUPPLY KIT,1005750,CDM,270,RC,,,outpatient,,,24.75,12.38,,24.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,90,
MONO TEST,1006008,CDM,300,RC,,,outpatient,,,65.5,32.75,,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.99,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,60.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,62.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,102.86,
RA FACTOR QUAL,1006010,CDM,300,RC,,,outpatient,,,51.75,25.88,,50.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,46.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,35.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.29,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,47.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,49.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,50.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.14,102.86,
Basic metabolic panel,1007031,CDM,300,RC,,,outpatient,,,159.5,79.75,,154.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,143.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,143.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,116.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,108.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,128.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,105.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.42,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,146.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,151.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,154.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,143.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.46,143.55,
"Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)",1007032,CDM,300,RC,,,outpatient,,,130.75,65.38,,126.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.08,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,95.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,105.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.46,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,120.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,124.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,7.01,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.01,117.68,
Test of glucose level in the blood,1007040,CDM,300,RC,,,outpatient,,,100.75,50.38,,97.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,90.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,73.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,68.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,81.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,66.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.41,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,92.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,95.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,97.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.75,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.75,102.86,
GTT ADDITIOL SPECIMEN,1007041,CDM,300,RC,,,outpatient,,,45.75,22.88,,44.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,41.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.29,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,42.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.92,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.92,102.86,
Test to predict likelihood of gestatiol diabetes,1007042,CDM,300,RC,,,outpatient,,,161.75,80.88,,156.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.15,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,145.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,145.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,117.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,130.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,148.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,153.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,156.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,145.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.87,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.87,145.58,
".G6PD, QNT - 1000960",1007050,CDM,300,RC,,,outpatient,,,39.5,19.75,,38.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.1,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,36.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,37.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,38.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.7,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.7,102.86,
"Blood test, lipids (cholesterol and triglycerides)",1007060,CDM,300,RC,,,outpatient,,,49.75,24.88,,48.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,44.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,33.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,32.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.08,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,45.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,47.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,48.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,44.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.39,102.86,
RF APO A-1,1007065,CDM,300,RC,,,outpatient,,,92.5,46.25,,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.45,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,67.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.47,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,85.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,21.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.09,102.86,
Obstetric blood test panel,1007074,CDM,300,RC,,,outpatient,,,409.75,204.88,,397.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,368.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,368.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,298.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,279.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,330.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,330.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,363.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,271.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.54,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,376.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,389.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,397.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,266.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,368.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,47.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.81,368.78,
.FINE NEEDLE ASPIRATE  - CYTOLOGY,1008000,CDM,311,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.28,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
CYTOLOGY SPUTUM,1008008,CDM,311,RC,,,outpatient,,,135.25,67.63,,131.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,121.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,92.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,109.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,124.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,131.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.73,
CYTOPATH EVAL NEEDLE ASP PRO ALL INCL BI,1008173,CDM,310,RC,,,outpatient,,,270.75,135.38,,262.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,162.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.28,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,243.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,243.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,162.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,184.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,162.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,218.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,239.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,179.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,219.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,249.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,257.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,262.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,175.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,162.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,162.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,162.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,243.68,
.RDL A 12 PLUS PROFILE (CHG ONLY),1009000,CDM,300,RC,,,outpatient,,,1149.25,574.63,,1114.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,689.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,344.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,1034.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1034.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,689.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,836.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,784.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,689.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,927.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,927.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1018.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,761.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,930.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1057.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,1091.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,1114.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,747.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,689.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,689.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,689.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1034.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,689.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,689.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1034.33,
.DEMENTIA AUTOIMMUNE EVAL (CHG ONLY),1009001,CDM,300,RC,,,outpatient,,,3316.25,1658.13,,3216.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,1989.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,994.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,2984.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,2984.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,1989.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2412.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2263.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1989.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2676.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2676.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2938.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2198.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2686.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3050.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,3150.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,3216.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,2155.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,1989.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1989.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1989.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2984.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,1989.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1989.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2984.63,
".Q FEVER ABS, IGG/IGM (CHG ONLY)",1009002,CDM,300,RC,,,outpatient,,,149.5,74.75,,145.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,134.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.55,
CYSTATIN C,1009003,CDM,300,RC,,,outpatient,,,287.5,143.75,,278.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.45,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,258.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,258.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,209.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,196.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,232.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,232.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,254.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,190.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,264.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,273.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,278.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,186.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,258.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.52,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.52,258.75,
Collection of venous blood by venipuncture,1009004,CDM,300,RC,,,outpatient,,,18.5,9.25,,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,17.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.57,102.86,
CAPILLARY PUNCTURE,1009005,CDM,300,RC,,,outpatient,,,16.5,8.25,,16.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,102.86,
"ISLET ANTIGEN 2 (IA-2) ANTIBODY, SERUM",1009608,CDM,300,RC,,,outpatient,,,161.25,80.63,,156.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.38,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,145.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,145.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,117.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,23.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,130.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,106.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,31.82,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,148.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,153.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,156.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,23.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,145.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,23.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.57,145.13,
.RUSSEL VIPER (DILUTE)-1000950,1010142,CDM,300,RC,,,outpatient,,,77,38.5,,74.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.3,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,56.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,51.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.93,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,70.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,73.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.58,102.86,
.LUPUS ANTICOAG - 1000950,1010145,CDM,300,RC,,,outpatient,,,77,38.5,,74.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.6,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,56.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,51.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.73,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,70.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,73.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,102.86,
.ASCA IGA -1000701 & 1000930,1010171,CDM,300,RC,,,outpatient,,,64,32,,62.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.54,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,58.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,60.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,62.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.25,102.86,
.ASCA IGG - 1000701 & 1000930,1010172,CDM,300,RC,,,outpatient,,,64,32,,62.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.54,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,58.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,60.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,62.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.25,102.86,
PAP smear,1010278,CDM,300,RC,,,outpatient,,,190.25,95.13,,184.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,171.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,171.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,138.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,129.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,153.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,153.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,168.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,126.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.92,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,175.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,180.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,184.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,123.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,171.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,26.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.61,171.23,
"HPV GENOTYPES 16 & 18,45",1010279,CDM,300,RC,,,outpatient,,,149.5,74.75,,145.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,108.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,40.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,120.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,54.74,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,137.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,40.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,134.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,40.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,40.55,134.55,
.ALPHA FETOPROTEIN-1000940,1010301,CDM,300,RC,,,outpatient,,,38.75,19.38,,37.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,34.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.64,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,35.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,36.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.77,102.86,
.ESTRIOL-1000940,1010302,CDM,300,RC,,,outpatient,,,38.75,19.38,,37.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,34.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32.64,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,35.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,36.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,24.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.18,102.86,
.GODOTROPIN-1000940,1010303,CDM,300,RC,,,outpatient,,,38.75,19.38,,37.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,34.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.32,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,35.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,36.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.05,102.86,
Blood test to monitor for cancer in the ovaries or testis,1010304,CDM,300,RC,,,outpatient,,,38.75,19.38,,37.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,34.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.05,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,35.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,36.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.59,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.59,102.86,
.CHEMISTRY-HEALTH FAIR,1010600,CDM,300,RC,,,outpatient,,,529.25,264.63,,513.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,317.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,476.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,476.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,317.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,385.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,361.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,317.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,427.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,427.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,468.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,350.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,428.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,486.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,502.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,513.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,344.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,317.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,317.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,317.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,476.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,317.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,317.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,476.33,
.CBC W/O DIFF W/PLTS-HEALTH FAIR,1010700,CDM,300,RC,,,outpatient,,,47.5,23.75,,46.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,42.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,38.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,43.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,45.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,46.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,28.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.5,90,
.SJOGRENS ABS (SSA)-1000752,1010801,CDM,300,RC,,,outpatient,,,33.25,16.63,,32.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.55,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,29.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.21,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,102.86,
.SJOGRENS ABS (SSB)-1000752,1010802,CDM,300,RC,,,outpatient,,,33.25,16.63,,32.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.55,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,29.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.21,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,102.86,
.IMMUNOGLOBULIN SUB 1 - 1000915,1010851,CDM,300,RC,,,outpatient,,,43.5,21.75,,42.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.83,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,40.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,39.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.02,102.86,
.IMMUNOGLOBULIN SUB 2-1000915,1010852,CDM,300,RC,,,outpatient,,,43.5,21.75,,42.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.83,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,40.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,39.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.02,102.86,
.IMMUNOGLOBULIN SUB 3-1000915,1010853,CDM,300,RC,,,outpatient,,,43.5,21.75,,42.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.83,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,40.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,39.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.02,102.86,
.IMMUNOGLOBULIN SUB 4-1000915,1010854,CDM,300,RC,,,outpatient,,,43.5,21.75,,42.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.83,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,40.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,39.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.02,102.86,
Blood test to monitor vitamin D levels,1010925,CDM,300,RC,,,outpatient,,,167,83.5,,161.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.65,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,150.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,121.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,134.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,39.96,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,153.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,161.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,150.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,29.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.6,150.3,
Blood test to measure average blood glucose levels for past 2-3 months,1010926,CDM,300,RC,,,outpatient,,,20.25,10.13,,19.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.11,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,18.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.71,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.71,102.86,
.CHEMISTRY-HOSPICE HF,1010927,CDM,300,RC,,,outpatient,,,561.5,280.75,,544.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,505.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,505.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,408.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,383.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,453.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,453.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,497.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,372.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,454.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,516.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,533.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,544.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,364.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,505.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,505.35,
Blood test to monitor for cancer,1010928,CDM,300,RC,,,outpatient,,,119.5,59.75,,115.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.04,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,107.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,86.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,81.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,96.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.09,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,109.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,113.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,115.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,107.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,20.81,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.81,107.55,
.CBC W/O DIFF W/PLTS HOSPICE HF,1010929,CDM,300,RC,,,outpatient,,,47.5,23.75,,46.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,42.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,38.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,43.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,45.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,46.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,28.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.5,90,
PSA (prostate specific antigen),1010930,CDM,300,RC,,,outpatient,,,80,40,,77.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.94,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,58.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,64.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.83,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,73.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,76,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.39,102.86,
"Blood test, thyroid stimulating hormone (TSH)",1010931,CDM,300,RC,,,outpatient,,,111.25,55.63,,107.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,80.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,75.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,89.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,73.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.68,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,102.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,105.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,107.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,100.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.8,102.86,
Blood test to determine infection with Hepatitis C,1010932,CDM,300,RC,,,outpatient,,,4.5,2.25,,4.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.27,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.26,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,4.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,4.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.05,102.86,
Blood test indicating infection with Hepatitis B,1010933,CDM,300,RC,,,outpatient,,,4.5,2.25,,4.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.27,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.27,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,4.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,4.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.05,102.86,
B12-FOLATE HOSPICE HF,1010934,CDM,300,RC,,,outpatient,,,5.25,2.63,,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,90,
.BARTONELLA QUINTA IGG AB-1000696,1011340,CDM,300,RC,,,outpatient,,,24,12,,23.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.74,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,22.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.18,102.86,
.BARTONELLA HENSELAE IGG-1000696,1011341,CDM,300,RC,,,outpatient,,,24,12,,23.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.74,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,22.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.18,102.86,
.BARTONELLA ABS IGM-1000696,1011342,CDM,300,RC,,,outpatient,,,46.5,23.25,,45.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,41.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.74,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,42.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,10.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.18,102.86,
ML  HEXAGOL PHOSPHOLIPID HPP,1011343,CDM,300,RC,,,outpatient,,,216.25,108.13,,209.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.58,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,157.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,147.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,174.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,191.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,143.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.27,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,198.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,205.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,209.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.98,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.98,194.63,
.SPECIMEN CONCENTRATION,1011348,CDM,300,RC,,,outpatient,,,25.5,12.75,,24.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.79,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.02,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,23.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.68,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.68,102.86,
.LYME (WESTERN) IGM-1000685,1011351,CDM,300,RC,,,outpatient,,,60.25,30.13,,58.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,43.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,41.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,48.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,53.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,39.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.91,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,55.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,57.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,58.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.49,102.86,
.LYME (WESTERN) IGG-1000685,1011352,CDM,300,RC,,,outpatient,,,60.25,30.13,,58.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,43.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,41.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,48.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,53.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,39.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.91,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,55.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,57.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,58.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.49,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.49,102.86,
ML  CD57 ANTIGENT QNT,1011353,CDM,300,RC,,,outpatient,,,121,60.5,,117.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,108.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,88.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,97.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.15,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,111.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,117.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,108.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,26.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.78,108.9,
ML  NK CELLS TOTAL COUNT,1011355,CDM,300,RC,,,outpatient,,,121,60.5,,117.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,108.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,88.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,97.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,50.94,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,111.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,117.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,108.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,37.73,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.73,108.9,
ML  HHV 6 IGM AB,1011367,CDM,300,RC,,,outpatient,,,328.5,164.25,,318.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.16,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,295.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,295.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,239.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,224.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,265.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,265.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,291.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,217.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.39,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,302.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,312.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,318.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,295.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,295.65,
ML  HHV 6 IGG AB,1011368,CDM,300,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.16,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.39,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,102.86,
ML  APTT 1 1 SALINE,1011370,CDM,300,RC,,,outpatient,,,216.25,108.13,,209.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.6,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,157.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,147.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,174.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,191.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,143.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.73,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,198.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,205.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,209.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,194.63,
.TETANUS AB (1001510),1011372,CDM,300,RC,,,outpatient,,,29.25,14.63,,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.24,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,26.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.99,102.86,
.DIPTHERIA AB (1001510),1011375,CDM,300,RC,,,outpatient,,,29.25,14.63,,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.24,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,26.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.99,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.99,102.86,
Test to measure creatinine in the urine,1011380,CDM,300,RC,,,outpatient,,,38.25,19.13,,37.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.99,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,35.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,36.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,102.86,
ML  PHENOCHROMOCYTOMA,1011381,CDM,300,RC,,,outpatient,,,38.25,19.13,,37.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.68,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.87,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,35.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,36.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.94,102.86,
ML  B2 GLYCOPROTEIN 1 ABS IGG,1011384,CDM,300,RC,,,outpatient,,,216.25,108.13,,209.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,157.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,147.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,174.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,191.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,143.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.36,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,198.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,205.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,209.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,194.63,
ML  DILUTE RUSSELLS VIPER VENOM TIME CON,1011388,CDM,300,RC,,,outpatient,,,216.25,108.13,,209.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.3,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,157.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,147.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,174.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,191.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,143.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.93,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,198.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,205.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,209.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.58,194.63,
ML  DILUTE RUSSELS VIPER VENON TIME SCRE,1011389,CDM,300,RC,,,outpatient,,,216.25,108.13,,209.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.3,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,157.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,147.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,174.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,191.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,143.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.93,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,198.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,205.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,209.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.58,194.63,
ML  THROMBIN TIME,1011390,CDM,300,RC,,,outpatient,,,216.25,108.13,,209.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,157.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,147.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,174.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,191.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,143.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.79,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,198.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,205.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,209.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.77,194.63,
ML  APTT 1 1 NP,1011391,CDM,300,RC,,,outpatient,,,216.25,108.13,,209.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.6,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,157.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,147.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,174.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,191.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,143.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.73,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,198.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,205.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,209.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,6.47,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.47,194.63,
ML  B2 GLYCOPROTEIN 2 ABS IGM,1011392,CDM,310,RC,,,outpatient,,,216.25,108.13,,209.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,157.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,147.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,174.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,191.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,143.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,,,,,Other,Not Separately reimbursable,198.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,205.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,209.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,194.63,
.ALK PHOS TOTAL-1000955,1011751,CDM,300,RC,,,outpatient,,,12.25,6.13,,11.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.99,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,11.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,102.86,
.ALK PHOS ISOENZYME-1000955,1011752,CDM,300,RC,,,outpatient,,,12.25,6.13,,11.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.95,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,11.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.03,102.86,
Blood test to determine cause of ippropriate blood clot formation,1011800,CDM,300,RC,,,outpatient,,,216.25,108.13,,209.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,157.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,147.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,174.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,191.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,143.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.36,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,198.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,205.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,209.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,194.63,
Blood test to determine cause of ippropriate blood clot formation,1011801,CDM,300,RC,,,outpatient,,,216.25,108.13,,209.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,157.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,147.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,174.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,191.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,143.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.36,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,198.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,205.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,209.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,194.63,
ML  FREE KAPPA QNT SERUM,1011803,CDM,300,RC,,,outpatient,,,65,32.5,,63.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.79,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,52.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.36,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,59.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.6,102.86,
ML  FREE LAMBDA QNT SERUM,1011804,CDM,300,RC,,,outpatient,,,65,32.5,,63.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.79,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,52.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.36,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,59.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.6,102.86,
ML  FREE KAPPA QNT URINE,1011805,CDM,300,RC,,,outpatient,,,75.5,37.75,,73.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.79,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,54.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,60.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.36,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,69.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,73.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.6,102.86,
ML  TRANSFORMING GROWTH FACTOR TGF BETA1,1011809,CDM,300,RC,,,outpatient,,,144.75,72.38,,140.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,105.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,116.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.31,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,133.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,130.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.27,130.28,
ML  COMPLEMENT C4A,1011810,CDM,300,RC,,,outpatient,,,334,167,,323.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,300.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,300.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,243.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,227.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,269.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,269.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,295.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,221.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.2,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,307.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,317.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,323.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,217.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,300.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12,300.6,
ML  MERCURY,1011811,CDM,300,RC,,,outpatient,,,94.25,47.13,,91.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.09,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,84.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,68.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,64.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,76.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,62.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.95,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,86.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,89.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,91.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,84.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.26,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.26,102.86,
ML  MELANOCYTE STIMULATING HORMONE MSH,1011812,CDM,300,RC,,,outpatient,,,385.75,192.88,,374.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.35,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,347.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,347.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,280.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,263.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,311.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,311.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,341.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,255.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.84,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,354.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,366.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,374.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,250.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,347.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.4,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.4,347.18,
ML  HLA DR1/2/4/5 DQ INTERMEDIATE RESOLU,1011813,CDM,300,RC,,,outpatient,,,474.75,237.38,,460.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,220.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,191.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,427.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,427.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,220.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,345.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,324.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,220.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,383.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,383.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,420.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,314.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,298,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,436.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,451.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,460.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,308.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,220.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,220.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,220.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,427.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,220.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,220.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90,427.28,
Blood test for an STD,1011814,CDM,300,RC,,,outpatient,,,316.5,158.25,,307.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,284.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,284.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,230.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,216.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,255.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,255.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,280.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,209.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,291.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,300.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,307.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,205.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,284.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,35.09,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.09,284.85,
ML  FREE LAMBDA QNT URINE,1011815,CDM,300,RC,,,outpatient,,,75.5,37.75,,73.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.79,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,54.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,60.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.36,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,69.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,73.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.6,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.6,102.86,
Testing for presence of drug,1011818,CDM,300,RC,,,outpatient,,,445.5,222.75,,432.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,400.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,324.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,304.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,359.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,359.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,394.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,295.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.89,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,409.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,423.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,432.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,289.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,400.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,400.95,
ML  B2 GLYCOPROTEIN 3 ABS IGA,1011819,CDM,300,RC,,,outpatient,,,216.25,108.13,,209.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,157.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,147.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,174.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,191.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,143.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.36,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,198.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,205.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,209.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,25.45,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.45,194.63,
ML THC SYNTHETIC WHOLE BLOOD,1011820,CDM,300,RC,,,outpatient,,,310.25,155.13,,300.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,186.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,279.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,279.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,186.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,225.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,211.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,186.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,250.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,274.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,205.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,251.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,285.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,294.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,300.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,201.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,186.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,279.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,186.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,186.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,279.23,
ML BUPHRENORPHINE WHOLE BLOOD,1011821,CDM,300,RC,,,outpatient,,,308.25,154.13,,299,97,,,percent of total billed charges,Pays at 97% of total billed charges,184.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,277.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,277.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,184.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,210.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,184.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,248.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,273.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,204.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,249.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,283.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,292.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,299,97,,,percent of total billed charges,Pays at 97% of total billed charges,200.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,184.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,277.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,184.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,184.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,277.43,
Testing for presence of drug,1011822,CDM,300,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.89,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,123.75,
.ALBUMIN SERUM-1001065,1012301,CDM,300,RC,,,outpatient,,,64.25,32.13,,62.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.29,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,57.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.68,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,59.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,62.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,57.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.95,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.95,102.86,
Test to determine levels of immunoglobulins in the blood,1012302,CDM,300,RC,,,outpatient,,,64.25,32.13,,62.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,57.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.56,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,59.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,62.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,57.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,102.86,
Test to determine levels of immunoglobulins in the blood,1012303,CDM,300,RC,,,outpatient,,,64.25,32.13,,62.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,57.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.56,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,59.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,62.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,57.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,102.86,
.ALBUMIN CSF-1001065,1012304,CDM,300,RC,,,outpatient,,,64.25,32.13,,62.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,57.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.5,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,59.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,62.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,57.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,7.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.78,102.86,
.OLIGOCLOL BANDS-1001065,1012401,CDM,300,RC,,,outpatient,,,64.25,32.13,,62.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,57.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,46.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.98,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,59.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,62.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,57.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,27.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.39,102.86,
Blood test to diagnose mononucleosis,1012801,CDM,300,RC,,,outpatient,,,49.5,24.75,,48.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,44.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,33.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,39.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,32.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.49,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,45.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,47.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,48.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,44.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.14,102.86,
Blood test to diagnose mononucleosis,1012802,CDM,300,RC,,,outpatient,,,46.25,23.13,,44.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,41.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.49,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,42.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.14,102.86,
.EBV EARLY ANTIGEN-1000870,1012803,CDM,300,RC,,,outpatient,,,49.5,24.75,,48.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,44.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,33.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,39.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,32.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.71,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,45.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,47.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,48.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,44.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.12,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.12,102.86,
.EBV NUCLEAR ANTIGEN-1000875,1012804,CDM,300,RC,,,outpatient,,,46.25,23.13,,44.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.25,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,41.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,37.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.64,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,42.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,41.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.29,102.86,
.ELECTROPHORESIS ELP-1000855,1013101,CDM,300,RC,,,outpatient,,,16.5,8.25,,16.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.5,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,15.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,10.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.74,102.86,
.ELECTROPH TOTAL PROT-1000835-1000855,1013102,CDM,300,RC,,,outpatient,,,16.5,8.25,,16.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.17,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.95,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,15.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.67,102.86,
.ARSENIC-1001215,1014101,CDM,300,RC,,,outpatient,,,71.25,35.63,,69.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,64.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,57.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.27,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,65.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,67.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,64.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,20.94,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.94,102.86,
Blood test to determine the concentration of lead in the blood,1014102,CDM,300,RC,,,outpatient,,,75,37.5,,72.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,67.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,54.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,60.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,49.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.35,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,69,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,72.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,67.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.11,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.11,102.86,
.HERPES TYPE I IGG-1000885,1015101,CDM,300,RC,,,outpatient,,,27.75,13.88,,26.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.81,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,25.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.19,102.86,
.HERPES TYPE II IGG-1000885,1015102,CDM,300,RC,,,outpatient,,,28,14,,27.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.78,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.12,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,25.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,19.35,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.35,102.86,
Test to determine levels of immunoglobulins in the blood,1015501,CDM,300,RC,,,outpatient,,,14.5,7.25,,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.56,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,13.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,102.86,
.IGE - 1000910,1015502,CDM,300,RC,,,outpatient,,,24.75,12.38,,24.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,19.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.22,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,22.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.46,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.46,102.86,
Test to determine levels of immunoglobulins in the blood,1015503,CDM,300,RC,,,outpatient,,,14.5,7.25,,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.56,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,13.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,102.86,
Test to determine levels of immunoglobulins in the blood,1015504,CDM,300,RC,,,outpatient,,,14.5,7.25,,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.56,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,13.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,102.86,
"INFLUENZA A & B, A",1015701,CDM,300,RC,,,outpatient,,,220.5,110.25,,213.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,74.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,198.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,160.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,150.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,95.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,177.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,177.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,195.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,146.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,129.33,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,202.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,209.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,213.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,143.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,95.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,95.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,95.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,198.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,95.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90,198.45,
.MUMPS ANTIBODY-1000880,1016301,CDM,300,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.62,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.05,102.86,
Blood test to determine if antibodies exist for rubella,1016302,CDM,300,RC,,,outpatient,,,110.25,55.13,,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,80.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,75.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,73.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.43,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,101.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,104.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.39,102.86,
Blood test to determine if antibodies exist for measles,1016303,CDM,300,RC,,,outpatient,,,52.5,26.25,,50.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.16,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,35.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,42.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.39,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,48.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,49.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,50.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,12.88,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.88,102.86,
Test to determine levels of immunoglobulins in the blood,1017001,CDM,300,RC,,,outpatient,,,14.5,7.25,,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.56,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,13.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,102.86,
Test to determine levels of immunoglobulins in the blood,1017002,CDM,300,RC,,,outpatient,,,14.5,7.25,,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.56,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,13.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,102.86,
Test to determine levels of immunoglobulins in the blood,1017003,CDM,300,RC,,,outpatient,,,14.5,7.25,,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.56,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,13.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.3,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.3,102.86,
.PROTEIN TOTAL URINE-1001200,1017102,CDM,300,RC,,,outpatient,,,28.75,14.38,,27.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.17,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,20.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,23.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.95,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,26.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.67,102.86,
.PROTEIN S FREE-1000945,1017201,CDM,300,RC,,,outpatient,,,73.5,36.75,,71.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.28,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,66.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,66.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,53.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,50.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,59.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,59.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,48.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.68,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,67.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,69.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,71.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,66.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,15.32,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.32,102.86,
.PROTEIN S TOTAL-1000945,1017202,CDM,300,RC,,,outpatient,,,73.5,36.75,,71.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,66.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,66.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,53.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,50.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,59.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,59.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,48.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.67,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,67.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,69.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,71.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,66.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,11.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.61,102.86,
.ANTI DS-D-1000975,1017651,CDM,300,RC,,,outpatient,,,16,8,,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.55,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,14.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.74,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.74,102.86,
.ANTI RNP-1000975,1017652,CDM,300,RC,,,outpatient,,,16,8,,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.55,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.21,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,14.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.4,102.86,
.SLE ANTIBODIES-1000975,1017653,CDM,300,RC,,,outpatient,,,62,31,,60.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,15.55,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,45.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,42.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.21,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,57.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,58.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,60.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,17.93,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,17.93,102.86,
.RA FACTOR QUAL-1000975,1017656,CDM,300,RC,,,outpatient,,,16,8,,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.65,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,14.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.67,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.67,102.86,
Blood test to evaluate thyroid function,1017901,CDM,300,RC,,,outpatient,,,37.5,18.75,,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.18,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,34.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.02,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.02,102.86,
"Blood test, thyroid stimulating hormone (TSH)",1017902,CDM,300,RC,,,outpatient,,,122.25,61.13,,118.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,110.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,88.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,98.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.68,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,112.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,118.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,110.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.8,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.8,110.03,
Blood test to screen for antibodies that could harm red blood cells,1019001,CDM,300,RC,,,outpatient,,,131.5,65.75,,127.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,118.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,95.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,106.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.19,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,120.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,124.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,127.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,118.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,9.77,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,9.77,118.35,
BB CROSSMATCH IS,1019101,CDM,300,RC,,,outpatient,,,144.75,72.38,,140.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,133.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.28,
"BB CROSSMATCH, AHG & IS",1019103,CDM,300,RC,,,outpatient,,,162,81,,157.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.02,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,145.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,145.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,153.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,145.8,
BB FFP,1019401,CDM,390,RC,,,outpatient,,,138.75,69.38,,134.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,124.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,124.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,94.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,122.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,112.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,127.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,131.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,134.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,83.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,124.88,
Blood test to measure levels of hemoglobin,1019811,CDM,300,RC,,,outpatient,,,18.5,9.25,,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.2,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,17.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.37,102.86,
.HCT (1019810),1019812,CDM,300,RC,,,outpatient,,,18.5,9.25,,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.2,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,17.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.37,102.86,
"Blood test, lipids (cholesterol and triglycerides)",1027061,CDM,300,RC,,,outpatient,,,48.25,24.13,,46.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,43.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,35.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.08,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,44.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,45.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,46.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,43.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.39,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.39,102.86,
Urine test,1088112,CDM,311,RC,,,outpatient,,,116.75,58.38,,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,107.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,105.08,
CYTOPATH EVAL F REPORT,1088173,CDM,310,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.28,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
PATH II Pro ALL INCLUSIVE BILLING ONLY,1088302,CDM,310,RC,,,outpatient,,,15.5,7.75,,15.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,102.86,
PATH III Pro ALL INCLUSIVE BILLING ONLY,1088304,CDM,310,RC,,,outpatient,,,23.5,11.75,,22.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,21.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,14.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.1,102.86,
Test of tissues for diagnosis of abnormalities,1088305,CDM,310,RC,,,outpatient,,,82.75,41.38,,80.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,67.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,76.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,102.86,
PATH DECALCIFIC PRO ALL INCLUS BILL ONLY,1088311,CDM,310,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,102.86,
Blood test to assist with diagnosis,1088312,CDM,310,RC,,,outpatient,,,59.25,29.63,,57.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,53.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,40.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,47.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,39.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,54.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,56.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,57.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.55,102.86,
IMMUNOCYTOCHEM EA  ADDT'L SINGLE,1088341,CDM,310,RC,,,outpatient,,,106.5,53.25,,103.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,95.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,72.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,97.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Pathology test,1088342,CDM,310,RC,,,outpatient,,,94.75,47.38,,91.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,85.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,64.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,56.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,62.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,76.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,87.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,90.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,91.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,56.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,56.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.85,102.86,
Pathology test,1088344,CDM,310,RC,,,outpatient,,,106.5,53.25,,103.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,95.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,72.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,97.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
MORPHOMETRIC ALYSIS USING COMP TECH,1088361,CDM,310,RC,,,outpatient,,,463.5,231.75,,449.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,278.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,417.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,417.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,278.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,337.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,316.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,278.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,374.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,374.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,410.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,307.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,375.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,426.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,440.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,449.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,301.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,278.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,278.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,278.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,417.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,278.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,278.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,417.15,
MORPHOMETRIC ALYSIS IN SITU HYBRID MAN,1088377,CDM,310,RC,,,outpatient,,,1037.75,518.88,,1006.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,622.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,933.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,933.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,622.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,755.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,708.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,622.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,837.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,837.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,919.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,688.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,840.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,954.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,985.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,1006.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,674.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,622.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,622.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,622.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,933.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,622.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,622.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,933.98,
IV START ED      N/C,2000001,CDM,272,RC,,,outpatient,,,17.5,8.75,,16.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,15.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.5,90,
EAR TUBE 1.27,2000002,CDM,278,RC,,,outpatient,,,57.5,28.75,,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,46.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,52.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,54.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,90,
EAR TUBE .14 EAR TUBES,2000003,CDM,278,RC,,,outpatient,,,53.25,26.63,,51.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,47.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,43.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.95,90,
DISP SUCTION HOSE 10',2000006,CDM,272,RC,,,outpatient,,,131,65.5,,127.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,117.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,106.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,120.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,124.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,127.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,78.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117.9,
IODOSORB BOX,2000007,CDM,270,RC,,,outpatient,,,63.75,31.88,,61.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,57.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,51.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,58.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,60.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,61.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.25,90,
UN FLEX BOOT,2000008,CDM,270,RC,,,outpatient,,,52.25,26.13,,50.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,35.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,49.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,50.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.35,90,
ROUTINE SET-UP,2000009,CDM,271,RC,,,outpatient,,,168.5,84.25,,163.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,151.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,151.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,115,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,101.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,149.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,111.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,136.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,155.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,160.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,163.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,101.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,101.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,151.65,
AMMONIUM LACTATE 12% MOISTURIZING LOTION,2000010,CDM,270,RC,,,outpatient,,,37.75,18.88,,36.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,33.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,34.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,36.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.65,90,
HYSEPT SOLUTION,2000011,CDM,270,RC,,,outpatient,,,47,23.5,,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,38.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,43.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,90,
UN BOOT BSN,2000012,CDM,270,RC,,,outpatient,,,36.25,18.13,,35.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,32.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,33.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.75,90,
DANKINS SOLUTION,2000014,CDM,270,RC,,,outpatient,,,41,20.5,,39.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,36.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.6,90,
OXYGEN PER HOUR,2000015,CDM,270,RC,,,outpatient,,,25.25,12.63,,24.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.15,90,
IODOSORB EA,2000017,CDM,270,RC,,,outpatient,,,27.25,13.63,,26.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,24.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.35,90,
SCREWDRIVER,2000018,CDM,272,RC,,,outpatient,,,947.75,473.88,,919.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,568.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,284.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,852.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,852.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,568.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,689.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,646.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,568.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,765.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,765.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,839.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,628.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,767.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,871.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,900.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,919.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,616.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,568.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,568.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,568.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,852.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,568.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,568.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,852.98,
OVER DRILL,2000019,CDM,272,RC,,,outpatient,,,545,272.5,,528.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,327,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,490.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,490.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,327,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,396.54,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,371.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,327,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,439.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,439.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,482.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,361.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,441.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,501.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,517.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,528.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,354.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,327,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,327,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,327,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,490.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,327,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,327,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,490.5,
TRIAHLON PS FEM,2000020,CDM,278,RC,,,outpatient,,,5528.75,2764.38,,5362.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,3317.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4975.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,4975.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,3317.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4022.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3773.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3317.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4462.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4462.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4899.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3665.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4478.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5086.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,5252.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,5362.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,3593.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,3317.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3317.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3317.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4975.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,3317.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3317.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4975.88,
TRIATHLON SYMMETRIC X3,2000021,CDM,278,RC,,,outpatient,,,1888.75,944.38,,1832.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,1133.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1699.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,1699.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,1133.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1374.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1289.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1133.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1524.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1524.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1673.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1252.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1529.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1737.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,1794.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,1832.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,1227.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,1133.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1133.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1133.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1699.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,1133.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1133.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1699.88,
PLURX DRAIGE,2000022,CDM,272,RC,,,outpatient,,,136.75,68.38,,132.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,123.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,90.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,110.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,125.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,129.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,132.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.08,
VESEAL,2000034,CDM,272,RC,,,outpatient,,,4917,2458.5,,4769.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,2950.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1475.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,4425.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4425.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,2950.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3577.61,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3355.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2950.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3969,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3969,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4356.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3259.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3982.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4523.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,4671.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,4769.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,3196.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,2950.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2950.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2950.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4425.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,2950.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2950.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4425.3,
PACKING STRIP PLAIN 1/2 X 2,2000038,CDM,271,RC,,,outpatient,,,6.75,3.38,,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,90,
PACKING STRIP PLAIN 1 X 5,2000039,CDM,270,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,
PACKING STRIP PLAIN 2 X 5,2000040,CDM,270,RC,,,outpatient,,,12,6,,11.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,
PACKING STRIP PLAIN 1/4,2000041,CDM,270,RC,,,outpatient,,,7,3.5,,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,90,
NEBULIZER-AEROECLISPE BAN,2000065,CDM,272,RC,,,outpatient,,,26,13,,25.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,23.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.6,90,
FILTER/MOUTHPIECE BAN,2000067,CDM,272,RC,,,outpatient,,,22.75,11.38,,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,90,
BAN MASK,2000068,CDM,272,RC,,,outpatient,,,22.75,11.38,,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,90,
FLANGE SKIN BARRIER,2000069,CDM,272,RC,,,outpatient,,,17,8.5,,16.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,90,
POUCH DRAIBLE 4'',2000070,CDM,272,RC,,,outpatient,,,5,2.5,,4.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,4.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,90,
PLATE CLAV FRACTURE,2000072,CDM,278,RC,,,outpatient,,,1909.25,954.63,,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1389.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1303.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1691.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1265.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1546.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1756.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,1813.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1241.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1718.33,
K WIRE 0.62X3''DIAM,2000073,CDM,270,RC,,,outpatient,,,90.25,45.13,,87.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,73.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,83.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,85.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,87.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,90,
SCREW HEX 2.5MMX 1411,2000074,CDM,278,RC,,,outpatient,,,505.5,252.75,,490.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,303.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,454.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,454.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,303.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,367.8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,345,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,303.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,408.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,408.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,447.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,335.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,409.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,465.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,480.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,490.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,328.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,303.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,303.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,303.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,454.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,303.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,303.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,454.95,
SCREW DRILL  2.7MM,2000075,CDM,278,RC,,,outpatient,,,236,118,,228.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,141.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,212.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,212.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,161.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,141.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,190.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,209.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,156.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,191.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,217.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,224.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,228.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,153.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,141.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,141.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,212.4,
SCREW CORTEX 3.5MMX10MM,2000076,CDM,278,RC,,,outpatient,,,157.75,78.88,,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,145.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.98,
LO PRO SCREW CORTEX 3.5MMX14MM,2000077,CDM,278,RC,,,outpatient,,,157.75,78.88,,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,145.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.98,
LO PRO SCREW CORTEX 3.5MMX10MM,2000078,CDM,278,RC,,,outpatient,,,258.5,129.25,,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,176.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,229.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,171.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,209.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,237.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,245.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,232.65,
LO PRO SCREW CORTEX 3.5MMX14MM,2000079,CDM,278,RC,,,outpatient,,,258.5,129.25,,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,176.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,229.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,171.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,209.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,237.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,245.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,232.65,
LO PRO SCREW CORTEX 3.5MMX16MM,2000080,CDM,278,RC,,,outpatient,,,258.5,129.25,,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,176.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,229.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,171.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,209.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,237.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,245.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,232.65,
FEEDING TUBE JEJUL,2000085,CDM,272,RC,,,outpatient,,,169.25,84.63,,164.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,152.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,115.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,101.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,149.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,112.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,137.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,155.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,160.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,164.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,110.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,101.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,101.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,152.33,
FEEDING TUBE  CR,2000086,CDM,272,RC,,,outpatient,,,258.25,129.13,,250.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,232.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,176.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,228.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,171.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,209.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,237.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,245.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,250.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,167.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,232.43,
BIPOLAR SHELL 54MM OD,2000087,CDM,278,RC,,,outpatient,,,674,337,,653.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,606.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,606.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,490.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,460.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,544.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,544.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,597.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,446.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,545.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,620.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,640.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,653.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,438.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,606.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,606.6,
BIPOLAR SHELL 54MM OD,2000088,CDM,278,RC,,,outpatient,,,1123,561.5,,1089.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,336.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,1010.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1010.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,817.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,766.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,906.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,906.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,995.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,744.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,909.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1033.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,1066.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,1089.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,729.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1010.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1010.7,
BIPOLAR LINER 43-54/55MM OD X28MM ID,2000089,CDM,278,RC,,,outpatient,,,449.25,224.63,,435.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,404.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,404.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,326.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,306.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,362.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,362.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,398.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,297.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,363.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,413.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,426.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,435.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,292.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,404.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,404.33,
AVENIR LATERAL STEM CEM 6,2000090,CDM,278,RC,,,outpatient,,,3144.5,1572.25,,3050.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,1886.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,943.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,2830.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,2830.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1886.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2287.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2146.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1886.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2538.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2538.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2786.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2084.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2547.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2892.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,2987.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,3050.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,2043.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,1886.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1886.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1886.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2830.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1886.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1886.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2830.05,
AQUA PAK 340,2000092,CDM,270,RC,,,outpatient,,,6,3,,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,
OXYMASK OPEN 02MED,2000093,CDM,270,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,
MASK OXYKID PED  PENGUIN,2000094,CDM,270,RC,,,outpatient,,,31,15.5,,30.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,90,
OXYPLUS OPEN 02 LARGE,2000095,CDM,270,RC,,,outpatient,,,9.25,4.63,,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,90,
C PAP MASK SM,2000096,CDM,270,RC,,,outpatient,,,90.25,45.13,,87.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,73.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,83.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,85.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,87.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,90,
C PAP MASK MED,2000097,CDM,270,RC,,,outpatient,,,90.25,45.13,,87.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,73.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,83.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,85.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,87.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,90,
C PAP MASK LG,2000098,CDM,270,RC,,,outpatient,,,90.25,45.13,,87.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,73.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,83.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,85.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,87.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,90,
SLIMLINE TUBING,2000099,CDM,270,RC,,,outpatient,,,27,13.5,,26.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,24.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.2,90,
STERILE WATER F/INHALATION,2000100,CDM,270,RC,,,outpatient,,,9.25,4.63,,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,90,
NEBULIZER AEROGON SOLO,2000105,CDM,270,RC,,,outpatient,,,151.5,75.75,,146.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,136.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,103.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,122.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,100.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,122.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,139.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,143.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,146.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,136.35,
NEBULIZER MISTY FAST,2000106,CDM,270,RC,,,outpatient,,,6.25,3.13,,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,90,
SQUIRT NOZZLE & SHIELD,2000107,CDM,272,RC,,,outpatient,,,31,15.5,,30.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,90,
MOUTH PIECE  MGC,2000108,CDM,270,RC,,,outpatient,,,5.25,2.63,,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,90,
MOUTHPIECE PFT,2000109,CDM,270,RC,,,outpatient,,,10,5,,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,30,,,percent of total billed charges,Pays at 30% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,90,
BONE CEMENT refobcin,2000110,CDM,278,RC,,,outpatient,,,371,185.5,,359.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,333.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,333.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,253.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,299.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,328.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,245.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,300.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,341.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,352.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,359.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,241.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,333.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,333.9,
PSN FEM PS CM CCR STD SZ7R,2000111,CDM,278,RC,,,outpatient,,,4492,2246,,4357.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1347.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3268.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3065.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3625.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3625.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3980.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2978.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3638.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4132.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,4267.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,4357.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,2919.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4042.8,
PSN ASF PS 11MM VE R 6-9 CD,2000112,CDM,278,RC,,,outpatient,,,2470.75,1235.38,,2396.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,741.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1797.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1686.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1994.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1994.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2189.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1638.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2001.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2273.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,2347.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,2396.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,1605.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2223.68,
ALL POLY PAT VE 29MM DIA,2000113,CDM,278,RC,,,outpatient,,,1123,561.5,,1089.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,336.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,1010.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1010.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,817.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,766.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,906.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,906.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,995.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,744.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,909.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1033.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,1066.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,1089.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,729.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1010.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1010.7,
PSN TIB STM 5 DEG SZ D R,2000114,CDM,278,RC,,,outpatient,,,1909.25,954.63,,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,572.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1389.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1303.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1691.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1265.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1546.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1756.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,1813.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1241.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1718.33,
BIPOLAR SHELL 45MM OD,2000115,CDM,278,RC,,,outpatient,,,674,337,,653.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,606.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,606.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,490.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,460.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,544.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,544.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,597.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,446.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,545.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,620.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,640.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,653.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,438.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,606.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,606.6,
BIPOLAR SHELL 45MM OD,2000116,CDM,278,RC,,,outpatient,,,1123,561.5,,1089.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,336.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,1010.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1010.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,817.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,766.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,906.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,906.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,995.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,744.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,909.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1033.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,1066.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,1089.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,729.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1010.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1010.7,
BIPOLAR LINER 44/45/46,2000117,CDM,278,RC,,,outpatient,,,449.25,224.63,,435.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,404.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,404.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,326.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,306.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,362.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,362.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,398.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,297.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,363.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,413.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,426.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,435.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,292.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,404.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,404.33,
AVENIR MULLER STANDARD STEMS,2000118,CDM,278,RC,,,outpatient,,,3593.75,1796.88,,3485.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1078.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,3234.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,3234.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2614.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2452.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2900.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2900.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3184.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2382.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2910.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3306.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,3414.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,3485.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,2335.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3234.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3234.38,
MASK SMALL HFNC CONNECT,2000119,CDM,270,RC,,,outpatient,,,99.25,49.63,,96.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,89.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,80.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,91.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,94.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,96.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,90,
MASK MED HFNC CONNECT,2000120,CDM,270,RC,,,outpatient,,,99.25,49.63,,96.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,89.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,80.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,91.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,94.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,96.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,90,
MASK Large HFNC CONNECT,2000121,CDM,270,RC,,,outpatient,,,99.25,49.63,,96.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,89.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,80.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,91.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,94.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,96.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,90,
NEBULIZER ELBOW EE,2000122,CDM,270,RC,,,outpatient,,,21.5,10.75,,20.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.9,90,
NEBULIZER ELBOW SE,2000123,CDM,270,RC,,,outpatient,,,21.5,10.75,,20.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.9,90,
BARTHLON GLAND ABSCESS PK,2000124,CDM,272,RC,,,outpatient,,,179.25,89.63,,173.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,161.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,161.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,122.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,144.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,158.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,118.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,145.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,164.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,170.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,173.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,116.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,161.33,
RAPID RHINO-ROCKET ANTERIOR AIRWAY,2000125,CDM,272,RC,,,outpatient,,,191.5,95.75,,185.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,172.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,172.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,130.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,114.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,169.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,126.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,155.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,176.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,181.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,185.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,114.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,114.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,172.35,
REAMER LOW PROFILE,2000126,CDM,278,RC,,,outpatient,,,636,318,,616.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,381.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,572.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,572.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,381.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,462.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,434.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,381.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,513.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,513.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,563.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,421.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,515.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,585.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,604.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,616.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,413.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,381.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,572.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,381.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,381.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,572.4,
DRILL 100 CANULATED,2000127,CDM,272,RC,,,outpatient,,,636,318,,616.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,381.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,572.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,572.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,381.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,462.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,434.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,381.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,513.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,513.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,563.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,421.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,515.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,585.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,604.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,616.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,413.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,381.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,572.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,381.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,381.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,572.4,
SUTURE POLYSORB - TIE,2000160,CDM,272,RC,,,outpatient,,,12.25,6.13,,11.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,90,
SUTURE POLYSORB - SINGLE,2000162,CDM,272,RC,,,outpatient,,,42.25,21.13,,40.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,38.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.35,90,
SUTURE POLYSORB -,2000164,CDM,272,RC,,,outpatient,,,46.5,23.25,,45.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,41.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,37.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,42.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.9,90,
SUTURE SURGIPRO,2000168,CDM,272,RC,,,outpatient,,,12.75,6.38,,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,
suture surgigut CHROMIC - TIE,2000170,CDM,272,RC,,,outpatient,,,25.5,12.75,,24.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.3,90,
SUTURE SURGIGUT - CHROMIC,2000172,CDM,272,RC,,,outpatient,,,14,7,,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,90,
SUTURE SURGIGUT - PLAIN,2000174,CDM,272,RC,,,outpatient,,,7,3.5,,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,90,
SUTURE SOFSILK - SINGLE,2000178,CDM,272,RC,,,outpatient,,,8.25,4.13,,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,90,
SUTURE SOFSILK - 5 PACK,2000180,CDM,272,RC,,,outpatient,,,30,15,,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9,30,,,percent of total billed charges,Pays at 30% of total billed charges,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,27.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,90,
PLATE ULR,2000181,CDM,278,RC,,,outpatient,,,1087.5,543.75,,1054.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,652.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,326.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,978.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,978.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,652.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,791.27,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,742.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,652.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,877.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,877.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,963.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,721.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,880.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1000.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,1033.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,1054.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,706.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,652.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,652.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,652.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,978.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,652.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,652.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,978.75,
SUTURE SURGIDAC - SINGLE,2000182,CDM,272,RC,,,outpatient,,,24.75,12.38,,24.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,90,
SUTURE SURGIDAC -,2000184,CDM,272,RC,,,outpatient,,,36.25,18.13,,35.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,32.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,33.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.75,90,
DRESSING antimicrobial FOAM,2000187,CDM,272,RC,,,outpatient,,,6,3,,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,
DRESSING antimicrobial FOAM 4 X 4,2000188,CDM,272,RC,,,outpatient,,,24.75,12.38,,24.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,90,
CANNULATED GUIDE PIN,2000193,CDM,272,RC,,,outpatient,,,183.25,91.63,,177.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,164.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,125.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,148.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,168.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,174.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,177.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,119.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,164.93,
ACUCARE HFNC SMALL,2000194,CDM,272,RC,,,outpatient,,,100.25,50.13,,97.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,90.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,68.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,66.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,81.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,92.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,95.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,97.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,90.23,
ACUCARE HFNC MED,2000195,CDM,272,RC,,,outpatient,,,100.25,50.13,,97.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,90.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,68.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,66.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,81.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,92.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,95.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,97.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,90.23,
ACUCARE HFNC LRG,2000196,CDM,272,RC,,,outpatient,,,100.25,50.13,,97.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,90.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,68.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,66.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,81.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,92.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,95.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,97.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,90.23,
PSN TIB STIM 5 DEG SZ C R,2000197,CDM,278,RC,,,outpatient,,,2387,1193.5,,2315.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2148.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,2148.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1736.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1629.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1926.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1926.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2115.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1582.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1933.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2196.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,2267.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,2315.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,1551.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2148.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2148.3,
DIA 28MM COCR MOD HD 3MM NK,2000198,CDM,278,RC,,,outpatient,,,1085,542.5,,1052.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,325.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,976.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,976.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,789.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,740.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,875.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,875.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,961.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,719.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,878.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,998.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,1030.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,1052.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,705.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,976.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,976.5,
PLATE HUMERAL SUTURE 3 HOLE,2000205,CDM,278,RC,,,outpatient,,,3244.25,1622.13,,3146.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,1946.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,973.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,2919.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,2919.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,1946.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2360.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2214.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1946.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2618.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2618.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2874.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2150.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2627.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2984.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,3082.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,3146.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,2108.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,1946.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1946.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1946.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2919.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,1946.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1946.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2919.83,
K WIRE 1.6MMX150MM,2000206,CDM,270,RC,,,outpatient,,,90.25,45.13,,87.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,73.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,83.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,85.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,87.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,90,
SCREW CORTICAL 3.5MMX20MM,2000207,CDM,278,RC,,,outpatient,,,195.75,97.88,,189.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,176.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,176.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,133.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,158.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,173.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,129.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,158.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,180.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,185.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,189.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,127.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,176.18,
SCREW FRAC PLATE LOC CORT 3.5X22MM,2000208,CDM,278,RC,,,outpatient,,,243.25,121.63,,235.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,218.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,218.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,166.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,196.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,215.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,161.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,197.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,223.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,231.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,235.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,158.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,218.93,
SCREW FRAC PLATE LOC CORT 3.5X24MM,2000209,CDM,278,RC,,,outpatient,,,243.25,121.63,,235.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,218.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,218.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,166.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,196.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,215.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,161.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,197.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,223.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,231.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,235.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,158.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,218.93,
SCREW CORTICAL 3.5MM X24,2000210,CDM,278,RC,,,outpatient,,,195.75,97.88,,189.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,176.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,176.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,133.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,158.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,173.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,129.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,158.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,180.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,185.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,189.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,127.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,176.18,
SCREW PLT FRASC CORT 3.5X34MM,2000211,CDM,278,RC,,,outpatient,,,243.25,121.63,,235.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,218.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,218.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,166.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,196.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,215.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,161.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,197.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,223.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,231.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,235.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,158.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,218.93,
SCREW PLT FRASC CORT 3.5X36MM,2000212,CDM,278,RC,,,outpatient,,,243.25,121.63,,235.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,218.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,218.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,166.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,196.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,215.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,161.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,197.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,223.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,231.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,235.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,158.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,218.93,
SCREW PLT FRASC CORT 3.5X40MM,2000213,CDM,278,RC,,,outpatient,,,243.25,121.63,,235.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,218.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,218.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,166.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,196.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,215.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,161.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,197.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,223.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,231.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,235.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,158.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,145.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,218.93,
ARCOS 13X150MM SPL TPR DIST,2000214,CDM,278,RC,,,outpatient,,,6551.25,3275.63,,6354.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,3930.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,5896.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,5896.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,3930.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4766.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4471.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3930.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5288.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5288.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5805.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4343.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5306.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6027.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,6223.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,6354.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,4258.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,3930.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3930.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3930.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5896.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,3930.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3930.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,5896.13,
ARCOS CON SZ STD 60MM,2000215,CDM,278,RC,,,outpatient,,,12709.75,6354.88,,12328.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,7625.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,11438.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,11438.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,7625.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9247.61,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8674.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7625.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10259.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10259.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11262.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8426.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10294.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11692.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,12074.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,12328.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,8261.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,7625.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7625.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7625.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11438.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,7625.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7625.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,11438.78,
COCR MOD 28MM DIA HD 3MM NK,2000216,CDM,272,RC,,,outpatient,,,1085,542.5,,1052.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,325.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,976.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,976.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,789.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,740.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,875.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,875.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,961.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,719.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,878.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,998.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,1030.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,1052.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,705.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,976.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,976.5,
BIPOLAR SHELL 440D,2000217,CDM,278,RC,,,outpatient,,,651,325.5,,631.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,585.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,585.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,473.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,444.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,525.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,525.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,576.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,431.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,527.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,598.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,618.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,631.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,423.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,585.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,585.9,
SPLINT-LONG LEG-ADULT,2000228,CDM,270,RC,,,outpatient,,,172.25,86.13,,167.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,117.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,139.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,158.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,163.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,167.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,155.03,
EDEMA GLOVE,2000230,CDM,271,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,90,
COMPRILAN 10CMX10CM,2000231,CDM,272,RC,,,outpatient,,,83.75,41.88,,81.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,75.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,57.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,55.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,67.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,77.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,79.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,81.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.25,90,
COMPRILAN 12CMX10CM,2000232,CDM,272,RC,,,outpatient,,,99.5,49.75,,96.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,89.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,59.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,80.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,91.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,94.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,96.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,59.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,59.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.7,90,
WRIST SUPPORT,2000233,CDM,271,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
DERMOTONE BLADE - BROWN,2000236,CDM,272,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
DERMOTONE BLADE   PMFC,2000237,CDM,272,RC,,,outpatient,,,6.25,3.13,,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,90,
URETH CATH ADAPTER,2000246,CDM,272,RC,,,outpatient,,,5.25,2.63,,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,90,
SAF-CLENS,2000274,CDM,272,RC,,,outpatient,,,21,10.5,,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,90,
SAF-GEL,2000276,CDM,272,RC,,,outpatient,,,11,5.5,,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,90,
PROTECTIVE OINTMENT,2000278,CDM,272,RC,,,outpatient,,,6.5,3.25,,6.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,90,
KALOSTAT 2GM,2000280,CDM,272,RC,,,outpatient,,,24.5,12.25,,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,90,
ILEX CREAM,2000288,CDM,272,RC,,,outpatient,,,21.25,10.63,,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,90,
AIR CAST - ANKLE ER,2000290,CDM,270,RC,,,outpatient,,,56.5,28.25,,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,45.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,51.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,53.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,90,
AIR CAST - ANKLE SMALL UNIVERSAL ER,2000291,CDM,270,RC,,,outpatient,,,108.5,54.25,,105.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,97.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,74.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,65.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,71.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,87.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,99.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,103.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,105.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,65.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,65.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,97.65,
PERINEAL FOAM,2000292,CDM,272,RC,,,outpatient,,,12.5,6.25,,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,90,
EPI LOCK 8 X 12,2000296,CDM,272,RC,,,outpatient,,,115.5,57.75,,112.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,103.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.95,
SPLINT COCK UP RT/LT,2000300,CDM,270,RC,,,outpatient,,,62,31,,60.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,42.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,50.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,57.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,58.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,60.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.2,90,
SUTURE  PROLENE 4.0SH BLUE,2000301,CDM,272,RC,,,outpatient,,,48,24,,46.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,43.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,38.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,44.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,45.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,46.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.8,90,
GIA 60 STAPLER,2000303,CDM,272,RC,,,outpatient,,,127.25,63.63,,123.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,114.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,86.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,84.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,103.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,117.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,120.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,123.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,114.53,
GIA 60 PROXI MATE RL-STAPLER,2000304,CDM,272,RC,,,outpatient,,,227.25,113.63,,220.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,204.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,204.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,155.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,183.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,201.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,150.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,184.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,209.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,215.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,220.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,147.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,204.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,204.53,
SPLINT COCK UP RT MED,2000306,CDM,270,RC,,,outpatient,,,68,34,,65.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,61.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,45.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,55.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,62.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,65.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.8,90,
SPLINT COCK UP LEFT MED,2000307,CDM,270,RC,,,outpatient,,,66.25,33.13,,64.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,59.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,45.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,39.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,53.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,53.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,60.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,62.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,64.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,39.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,39.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.75,90,
SUTURE SURGIPRO4-0PC11BLUE,2000308,CDM,272,RC,,,outpatient,,,29.25,14.63,,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,90,
ARTHROSCOPY PUMP TUBE,2000318,CDM,272,RC,,,outpatient,,,152,76,,147.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,136.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,103.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,91.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,122.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,100.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,123.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,139.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,144.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,147.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,91.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,91.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,136.8,
CHEMOSITE MEDIPORT,2000320,CDM,278,RC,,,outpatient,,,440.25,220.13,,427.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,264.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,547.98,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,396.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,396.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,264.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,300.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,264.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,355.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,355.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,390.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,291.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,356.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,405.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,418.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,427.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,286.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,264.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,264.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,264.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,396.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,264.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,264.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,396.23,
COAXIAL ACHIEVE BIOPSY,2000321,CDM,272,RC,,,outpatient,,,174.25,87.13,,169.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,156.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,156.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,118.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,140.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,115.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,141.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,160.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,165.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,169.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,156.83,
COAXIAL ACHIEVE BIOPSY 16 G11CM,2000323,CDM,272,RC,,,outpatient,,,200.25,100.13,,194.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,120.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,180.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,180.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,136.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,120.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,161.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,177.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,132.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,162.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,184.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,190.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,194.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,130.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,120.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,120.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,180.23,
COAXIAL ACHIEVE BIOPSY 14 x 20CM,2000324,CDM,272,RC,,,outpatient,,,179.25,89.63,,173.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,161.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,161.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,122.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,144.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,158.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,118.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,145.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,164.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,170.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,173.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,116.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,161.33,
CHEMOSITE (INFUSION PORT),2000325,CDM,271,RC,,,outpatient,,,2885.75,1442.88,,2799.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,1731.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,865.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,2597.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,2597.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1731.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2099.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1969.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1731.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2329.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2329.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2557.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1913.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2337.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2654.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,2741.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,2799.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,1875.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,1731.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1731.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1731.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2597.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1731.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1731.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2597.18,
SPLINT /WRIST SHORT,2000328,CDM,270,RC,,,outpatient,,,22.75,11.38,,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,90,
SPLINT NIGHT/MED,2000329,CDM,270,RC,,,outpatient,,,173.5,86.75,,168.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,156.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,156.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,118.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,104.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,140.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,153.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,115.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,140.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,159.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,164.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,168.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,104.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,156.15,
PROCLUDE 6X6,2000330,CDM,272,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,
BINDER ABDOMIL XLG,2000334,CDM,271,RC,,,outpatient,,,100.75,50.38,,97.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,90.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,68.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,66.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,81.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,92.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,95.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,97.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,60.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,90.68,
KNEE SLEEVE ALL SIZES,2000336,CDM,270,RC,,,outpatient,,,65.5,32.75,,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,53.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,60.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,62.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,90,
CONVATEC POUCH 70MM 2 3/4,2000337,CDM,272,RC,,,outpatient,,,8.5,4.25,,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,90,
CONVATEC POUCH 70MM 2 1/4,2000338,CDM,272,RC,,,outpatient,,,5.75,2.88,,5.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,90,
SKIN BARRIER W/FLANGE 70MM,2000339,CDM,272,RC,,,outpatient,,,29.25,14.63,,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,90,
SKIN BARRIERW/FLANGE/CONVATEC,2000340,CDM,272,RC,,,outpatient,,,29.25,14.63,,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,90,
UROSTOMY  POUCH/CONVATEC,2000341,CDM,272,RC,,,outpatient,,,6.5,3.25,,6.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,90,
UROSTOMY  POUCH/CONVATEC,2000342,CDM,272,RC,,,outpatient,,,6.5,3.25,,6.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,90,
POUCH COLOSTOMY,2000343,CDM,271,RC,,,outpatient,,,6.75,3.38,,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,90,
COLOSTOMY POUCH ACT LIFE,2000344,CDM,272,RC,,,outpatient,,,6.75,3.38,,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,90,
SKIN BARRIER,2000345,CDM,271,RC,,,outpatient,,,7.5,3.75,,7.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,90,
COMBIDERM DRESSING 4X4,2000346,CDM,272,RC,,,outpatient,,,22.75,11.38,,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,90,
UROSTOMY FOR TWO PIECE POUCH,2000348,CDM,272,RC,,,outpatient,,,6.75,3.38,,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,90,
WOUND DRAIGE COLLECTOR,2000349,CDM,272,RC,,,outpatient,,,42.5,21.25,,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,39.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.5,90,
DRAIBLE POUCH ACT LIFE,2000350,CDM,272,RC,,,outpatient,,,7.5,3.75,,7.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,90,
DRAIBLE POUCH ACT LIFE  CUT TO FIT,2000351,CDM,272,RC,,,outpatient,,,6.75,3.38,,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,90,
urostomy pouch,2000352,CDM,272,RC,,,outpatient,,,42.25,21.13,,40.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,38.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.35,90,
SUR FIT SKIN BARRIER,2000353,CDM,272,RC,,,outpatient,,,7,3.5,,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,90,
SUR FIT UROSTOMY POUCH,2000355,CDM,272,RC,,,outpatient,,,8,4,,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,90,
SKIN BARRIER SEAL,2000356,CDM,272,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
ADHESIVE,2000357,CDM,272,RC,,,outpatient,,,30.5,15.25,,29.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,27.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.3,90,
BARRIER FILM 3.0,2000358,CDM,272,RC,,,outpatient,,,6,3,,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,
STOMAHESIVE POWDER,2000359,CDM,272,RC,,,outpatient,,,3.5,1.75,,3.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,90,
STOMAHESIVE PASTE,2000360,CDM,272,RC,,,outpatient,,,5.25,2.63,,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,90,
COHESIVE,2000362,CDM,272,RC,,,outpatient,,,17.25,8.63,,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,90,
liquid barrier film spray,2000364,CDM,272,RC,,,outpatient,,,45.25,22.63,,43.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,40.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,41.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,42.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,43.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.15,90,
EAKIN COHESIVE 2'',2000365,CDM,272,RC,,,outpatient,,,28,14,,27.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,90,
FLANGE TWO PIECE OSTOMY,2000366,CDM,272,RC,,,outpatient,,,30,15,,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9,30,,,percent of total billed charges,Pays at 30% of total billed charges,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,27.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,90,
FLANGE OSTOMY 2 3/4,2000367,CDM,272,RC,,,outpatient,,,30,15,,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9,30,,,percent of total billed charges,Pays at 30% of total billed charges,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,27.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,90,
POUCH DRAIN ACTIVE LIFE,2000368,CDM,272,RC,,,outpatient,,,9.5,4.75,,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,90,
POUCH DRAIN  CUT TO FIT  19X64,2000369,CDM,272,RC,,,outpatient,,,8.25,4.13,,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,90,
COBAN WRAP NONSTERLE,2000370,CDM,272,RC,,,outpatient,,,8,4,,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,90,
POUCH DRAIBLE 70MM,2000371,CDM,272,RC,,,outpatient,,,7.25,3.63,,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,90,
POUCH DRAIBLE 57MM,2000372,CDM,272,RC,,,outpatient,,,7.25,3.63,,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,90,
OSTOMY ring 40mm,2000373,CDM,272,RC,,,outpatient,,,21,10.5,,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,90,
COBAN WRAP 2  STERILE,2000374,CDM,272,RC,,,outpatient,,,8.5,4.25,,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,90,
COBAN WRAP 1  STERILE,2000375,CDM,272,RC,,,outpatient,,,19,9.5,,18.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,90,
COBAN WRAP 6  STERILE NONLATEX,2000376,CDM,272,RC,,,outpatient,,,12.25,6.13,,11.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,90,
COBAN WRAP 4  STERILE,2000377,CDM,272,RC,,,outpatient,,,7.25,3.63,,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,90,
COBAN WRAP 3  STERILE,2000378,CDM,272,RC,,,outpatient,,,6.5,3.25,,6.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,90,
CASTING TAPE 2'' DEEP BLUE,2000379,CDM,270,RC,,,outpatient,,,8.5,4.25,,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,90,
CASTING TAPE 3'' DEEP BLUE,2000380,CDM,270,RC,,,outpatient,,,10,5,,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,30,,,percent of total billed charges,Pays at 30% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,90,
CASTING TAPE 4'' DEEP BLUE,2000381,CDM,270,RC,,,outpatient,,,12.5,6.25,,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,90,
CASTING TAPE 2'' GREEN,2000382,CDM,270,RC,,,outpatient,,,19,9.5,,18.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,90,
CASTING TAPE 3'' GREEN,2000383,CDM,270,RC,,,outpatient,,,9.5,4.75,,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,90,
CASTING TAPE 4'' GREEN,2000384,CDM,270,RC,,,outpatient,,,27.75,13.88,,26.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,90,
CASTING TAPE 2'' RED,2000385,CDM,270,RC,,,outpatient,,,19,9.5,,18.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,90,
CASTING TAPE 3'' RED,2000386,CDM,270,RC,,,outpatient,,,22.75,11.38,,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,90,
CASTING TAPE 4'' RED,2000387,CDM,270,RC,,,outpatient,,,27.75,13.88,,26.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,90,
CASTING TAPE 2'' BLACK,2000388,CDM,270,RC,,,outpatient,,,8.5,4.25,,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,90,
CASTING TAPE 3'' BLACK,2000389,CDM,270,RC,,,outpatient,,,10,5,,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,30,,,percent of total billed charges,Pays at 30% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,90,
CASTING TAPE 4'' BLACK,2000390,CDM,270,RC,,,outpatient,,,13,6.5,,12.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,90,
COBAN WRAP 2  NO LATEX,2000391,CDM,272,RC,,,outpatient,,,6.5,3.25,,6.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,90,
COBAN WRAP 3  NONLATEX,2000392,CDM,272,RC,,,outpatient,,,6.25,3.13,,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,90,
COBAN WRAP 4  NONLATEX,2000393,CDM,272,RC,,,outpatient,,,7.5,3.75,,7.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,90,
COBAN WRAP 6  NONLATEX,2000394,CDM,272,RC,,,outpatient,,,35.75,17.88,,34.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,90,
POUCH DRAIBLE 4 1/3,2000395,CDM,272,RC,,,outpatient,,,31.75,15.88,,30.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,29.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,30.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.05,90,
COFLEX DRESSING w/zinc,2000396,CDM,272,RC,,,outpatient,,,38.25,19.13,,37.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,35.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,36.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.95,90,
COFLEX DRESSING 4x6,2000397,CDM,272,RC,,,outpatient,,,39.25,19.63,,38.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,35.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,31.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,36.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,37.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,38.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.55,90,
DERMIS GRAFT,2000398,CDM,272,RC,,,outpatient,,,4045.5,2022.75,,3924.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,2427.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1213.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,3640.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,3640.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,2427.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2943.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2761.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2427.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3265.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3265.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3584.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2682.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3276.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3721.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,3843.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,3924.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,2629.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,2427.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2427.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2427.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3640.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,2427.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2427.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3640.95,
PSN fem cr cmt ccr STD SZ7,2000401,CDM,278,RC,,,outpatient,,,4340,2170,,4209.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3906,90,,,percent of total billed charges,Pays at 90% of total billed charges,3906,90,,,percent of total billed charges,Pays at 90% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3157.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2962.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3503.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3503.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3845.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2877.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3515.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3992.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,4123,95,,,percent of total billed charges,Pays at 95% of total billed charges,4209.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,2821,65,,,percent of total billed charges,Pays at 65% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3906,90,,,percent of total billed charges,Pays at 90% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3906,
PSN TIB STM 5 DEG,2000402,CDM,278,RC,,,outpatient,,,1844.5,922.25,,1789.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1660.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1660.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1342.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1258.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1488.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1488.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1634.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1222.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1494.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1696.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,1752.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,1789.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,1198.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1660.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1660.05,
PSN ASF CR 10MM VE L3,2000404,CDM,278,RC,,,outpatient,,,2387,1193.5,,2315.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2148.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,2148.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1736.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1629.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1926.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1926.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2115.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1582.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1933.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2196.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,2267.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,2315.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,1551.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2148.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2148.3,
COMP RVRS 25MM BSPLT HA ADAPT,2000406,CDM,278,RC,,,outpatient,,,3255,1627.5,,3157.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,1953,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2929.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,2929.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,1953,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2368.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2221.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1953,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2627.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2627.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2884.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2158.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2636.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2994.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,3092.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,3157.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,2115.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,1953,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1953,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1953,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2929.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,1953,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1953,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2929.5,
COMP RVRS CNTRL 6.5X5MM,2000407,CDM,278,RC,,,outpatient,,,162.75,81.38,,157.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,111.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,131.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,144.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.48,
COMP NLK SCR 3.5 HEX 4.75 30ST,2000408,CDM,278,RC,,,outpatient,,,162.75,81.38,,157.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,111.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,131.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,144.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.48,
COMP NLK SCR 3.5 HEX 4.75 25ST,2000409,CDM,278,RC,,,outpatient,,,162.75,81.38,,157.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,111.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,131.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,144.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.48,
COMP LK SCR 3.5 HEX 4.75 30ST,2000410,CDM,278,RC,,,outpatient,,,162.75,81.38,,157.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,111.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,131.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,144.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.48,
COMP RVRS SHLDR GLNSP STD 36MM,2000411,CDM,278,RC,,,outpatient,,,2604,1302,,2525.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,1562.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2343.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2343.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,1562.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1894.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1777.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1562.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2101.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2101.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2307.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1726.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2109.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2395.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,2473.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,2525.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,1692.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,1562.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1562.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1562.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2343.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,1562.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1562.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2343.6,
COMP 6MM HUM FRACT STEM PPS,2000412,CDM,278,RC,,,outpatient,,,7378,3689,,7156.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,4426.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,6640.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,6640.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4426.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5368.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5035.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4426.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5955.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5955.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6537.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4891.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5976.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6787.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,7009.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,7156.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,4795.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,4426.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4426.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4426.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6640.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4426.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4426.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,6640.2,
HMRL BEARING 36MM +3 PRLNG,2000413,CDM,278,RC,,,outpatient,,,1519,759.5,,1473.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,911.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1367.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,1367.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,911.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1105.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1036.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,911.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1226.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1226.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1345.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1007.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1230.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1397.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,1443.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,1473.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,987.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,911.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,911.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,911.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1367.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,911.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,911.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1367.1,
HMRL TRAY +3STD,2000414,CDM,278,RC,,,outpatient,,,2474,1237,,2399.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,1484.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2226.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2226.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,1484.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1800.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1688.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1484.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1997.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1997.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2192.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1640.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2003.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2276.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,2350.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,2399.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,1608.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,1484.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1484.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1484.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2226.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,1484.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1484.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2226.6,
COMP RVS 3.2 MM DRILL,2000415,CDM,272,RC,,,outpatient,,,228,114,,221.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,136.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,205.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,205.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,155.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,136.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,184.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,202.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,151.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,184.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,209.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,216.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,221.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,148.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,136.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,136.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,205.2,
COMP RVS 2.7 MM DIA DRL,2000416,CDM,272,RC,,,outpatient,,,289.75,144.88,,281.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,173.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,260.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,260.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,173.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,197.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,173.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,233.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,233.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,256.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,192.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,234.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,266.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,275.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,281.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,188.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,173.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,260.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,173.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,173.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,260.78,
AVENIR MULLER LATERAL STEM 4,2000417,CDM,278,RC,,,outpatient,,,3472,1736,,3367.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3124.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,3124.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2526.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2369.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2802.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2802.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3076.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2301.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2812.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3194.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,3298.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,3367.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,2256.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3124.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3124.8,
ZB12/14 cocr hd 22mm xo,2000418,CDM,278,RC,,,outpatient,,,1085,542.5,,1052.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,976.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,976.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,789.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,740.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,875.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,875.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,961.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,719.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,878.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,998.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,1030.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,1052.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,705.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,976.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,976.5,
BIPOLAR LINE 42/43 OD X 22MM ID,2000419,CDM,278,RC,,,outpatient,,,434,217,,420.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,260.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,390.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,390.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,260.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,315.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,296.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,260.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,350.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,350.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,384.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,287.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,351.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,399.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,412.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,420.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,282.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,260.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,260.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,260.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,390.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,260.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,260.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,390.6,
SCREW CANNULATED 6.5X95MM,2000420,CDM,272,RC,,,outpatient,,,197.31,98.66,,191.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.19,30,,,percent of total billed charges,Pays at 30% of total billed charges,177.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,177.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,134.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,118.39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,159.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,130.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,159.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,181.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,187.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,191.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,128.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,118.39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,118.39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,177.58,
ALLOSYNC DBM CHIPS 5CC,2000421,CDM,272,RC,,,outpatient,,,1497,748.5,,1452.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,898.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,449.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,1347.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1347.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,898.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1089.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1021.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,898.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1208.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1208.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1326.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,992.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1212.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1377.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,1422.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,1452.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,973.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,898.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,898.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,898.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1347.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,898.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,898.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1347.3,
WRIST FUSION PLATE STD BEND 120MM,2000422,CDM,278,RC,,,outpatient,,,3334.5,1667.25,,3234.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,2000.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1000.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,3001.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,3001.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,2000.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2426.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2275.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2000.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2691.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2691.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2954.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2210.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2700.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3067.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,3167.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,3234.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,2167.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,2000.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2000.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2000.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3001.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,2000.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2000.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3001.05,
WRIST FUSION PLATE STD BEND 123MM,2000423,CDM,278,RC,,,outpatient,,,3334.5,1667.25,,3234.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,2000.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1000.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,3001.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,3001.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,2000.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2426.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2275.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2000.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2691.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2691.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2954.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2210.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2700.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3067.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,3167.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,3234.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,2167.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,2000.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2000.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2000.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3001.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,2000.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2000.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3001.05,
SCREW CANNULATED 6.5X95MM,2000424,CDM,278,RC,,,outpatient,,,547,273.5,,530.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,328.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,492.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,492.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,328.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,398,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,373.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,328.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,441.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,441.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,484.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,362.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,443.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,503.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,519.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,530.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,355.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,328.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,492.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,328.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,328.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,492.3,
SCREW CANNULATED 6.5X100MM,2000425,CDM,278,RC,,,outpatient,,,547,273.5,,530.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,328.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,492.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,492.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,328.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,398,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,373.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,328.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,441.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,441.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,484.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,362.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,443.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,503.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,519.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,530.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,355.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,328.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,492.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,328.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,328.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,492.3,
SCREW CANNULATED 6.5X95MM,2000426,CDM,278,RC,,,outpatient,,,197.5,98.75,,191.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,177.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,177.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,134.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,118.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,159.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,175,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,130.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,159.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,181.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,187.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,191.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,128.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,118.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,118.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,177.75,
BIPOLAR SHELL 43MM OD,2000427,CDM,278,RC,,,outpatient,,,651,325.5,,631.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,585.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,585.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,473.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,444.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,525.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,525.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,576.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,431.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,527.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,598.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,618.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,631.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,423.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,585.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,585.9,
SCREW CORTEX 3.5X12MM,2000428,CDM,278,RC,,,outpatient,,,90.75,45.38,,88.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,81.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,60.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,73.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,83.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,86.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,88.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.45,90,
SCREW CORTEX 3.5X14MM,2000429,CDM,278,RC,,,outpatient,,,90.75,45.38,,88.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,81.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,60.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,73.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,83.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,86.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,88.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.45,90,
SCREW CORTEX 3.5X22MM,2000431,CDM,278,RC,,,outpatient,,,90.75,45.38,,88.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,81.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,60.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,73.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,83.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,86.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,88.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.45,90,
PLATE ONE THIRD TUBULAR,2000432,CDM,278,RC,,,outpatient,,,329.5,164.75,,319.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,296.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,296.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,239.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,224.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,265.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,265.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,291.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,218.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,266.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,303.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,313.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,319.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,214.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,296.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,296.55,
SCREW CANCELLOUS 4.0X14,2000433,CDM,278,RC,,,outpatient,,,74.75,37.38,,72.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,49.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,60.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,68.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,72.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,90,
SCREW CANCELLOUS 4.0X16,2000434,CDM,278,RC,,,outpatient,,,74.75,37.38,,72.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,49.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,60.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,68.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,72.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,90,
SCREW CANCELLOUS 4.0X18,2000435,CDM,278,RC,,,outpatient,,,74.75,37.38,,72.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,49.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,60.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,68.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,72.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,90,
CABLE READY gtr cable cocr 1.8x635mm,2000436,CDM,272,RC,,,outpatient,,,384,192,,372.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,230.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,345.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,345.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,230.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,279.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,262.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,230.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,309.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,309.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,340.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,254.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,311.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,353.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,364.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,372.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,249.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,230.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,230.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,230.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,345.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,230.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,230.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,345.6,
CABLE READY gtr cable cocr 1.8x635mm,2000437,CDM,272,RC,,,outpatient,,,575,287.5,,557.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,345,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,517.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,517.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,345,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,418.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,392.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,345,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,464.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,464.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,509.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,381.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,465.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,529,92,,,percent of total billed charges,Pays at 92% of total billed charges,546.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,557.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,373.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,345,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,345,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,345,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,517.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,345,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,345,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,517.5,
ECHO POR FMRL RED LAT RPPNC 11X135,2000439,CDM,278,RC,,,outpatient,,,3472,1736,,3367.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3124.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,3124.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2526.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2369.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2802.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2802.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3076.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2301.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2812.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3194.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,3298.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,3367.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,2256.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3124.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3124.8,
CER BIOLOX OPTION HD28MM,2000440,CDM,278,RC,,,outpatient,,,1410.5,705.25,,1368.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,846.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1269.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,1269.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,846.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1026.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,962.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,846.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1138.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1138.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1249.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,935.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1142.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1297.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,1339.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,1368.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,916.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,846.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,846.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,846.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1269.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,846.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,846.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1269.45,
LONGEVITY DM BEARING 28X38MM,2000441,CDM,278,RC,,,outpatient,,,1844.5,922.25,,1789.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1660.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1660.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1342.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1258.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1488.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1488.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1634.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1222.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1494.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1696.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,1752.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,1789.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,1198.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1660.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1660.05,
G7 DUAL MOBILITY LINER 38MM C,2000442,CDM,278,RC,,,outpatient,,,3780.25,1890.13,,3666.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,2268.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3402.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,3402.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,2268.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2750.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2580.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2268.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3051.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3051.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3349.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2506.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3062,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3477.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,3591.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,3666.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,2457.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,2268.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2268.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2268.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3402.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,2268.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2268.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3402.23,
G7 OSSEOTI 3 HOLE SHELL 48MM C,2000443,CDM,278,RC,,,outpatient,,,5517.25,2758.63,,5351.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,3310.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4965.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4965.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,3310.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4014.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3765.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3310.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4453.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4453.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4888.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3657.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4468.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5075.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,5241.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,5351.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,3586.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,3310.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3310.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3310.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4965.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,3310.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3310.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4965.53,
STIMULAN RAPID CURE 10CC,2000444,CDM,278,RC,,,outpatient,,,4763.25,2381.63,,4620.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,2857.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4286.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,4286.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,2857.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3465.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3250.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2857.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3844.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3844.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4220.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3158.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3858.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4382.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,4525.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,4620.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,3096.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,2857.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2857.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2857.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4286.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,2857.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2857.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4286.93,
ECHO POR FMRL RPP NC 12X140MM,2000445,CDM,278,RC,,,outpatient,,,3472,1736,,3367.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3124.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,3124.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2526.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2369.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2802.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2802.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3076.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2301.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2812.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3194.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,3298.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,3367.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,2256.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3124.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3124.8,
G7 VIT E NEUTRAL LNR 36MMF,2000446,CDM,278,RC,,,outpatient,,,2495.5,1247.75,,2420.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,1497.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2245.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,2245.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,1497.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1815.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1703.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1497.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2014.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2014.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2211.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1654.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2021.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2295.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,2370.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,2420.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,1622.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,1497.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1497.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1497.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2245.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,1497.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1497.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2245.95,
PSN TIB PS CMT CCR NRW SZ6 R,2000447,CDM,278,RC,,,outpatient,,,4340,2170,,4209.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3906,90,,,percent of total billed charges,Pays at 90% of total billed charges,3906,90,,,percent of total billed charges,Pays at 90% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3157.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2962.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3503.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3503.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3845.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2877.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3515.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3992.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,4123,95,,,percent of total billed charges,Pays at 95% of total billed charges,4209.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,2821,65,,,percent of total billed charges,Pays at 65% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3906,90,,,percent of total billed charges,Pays at 90% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3906,
PSN ASF PS 10MM VE R 6-9 CD,2000448,CDM,278,RC,,,outpatient,,,2387,1193.5,,2315.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2148.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,2148.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1736.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1629.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1926.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1926.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2115.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1582.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1933.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2196.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,2267.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,2315.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,1551.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2148.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2148.3,
ECHO POR fmrl rpp nc 10x130mm,2000449,CDM,278,RC,,,outpatient,,,3472,1736,,3367.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3124.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,3124.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2526.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2369.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2802.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2802.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3076.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2301.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2812.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3194.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,3298.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,3367.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,2256.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3124.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3124.8,
PLATE 6 HOLE,2000450,CDM,278,RC,,,outpatient,,,324,162,,314.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,291.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,291.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,221.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,261.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,261.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,214.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,262.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,298.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,307.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,314.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,210.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,291.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,291.6,
SCREW CORTEX 3.5X24MM,2000451,CDM,278,RC,,,outpatient,,,65,32.5,,63.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,52.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,59.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39,90,
SCREW CORTEX 3.5X14MM,2000452,CDM,278,RC,,,outpatient,,,65,32.5,,63.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,52.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,59.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39,90,
SCREW CORTEX 3.5X12MM,2000453,CDM,278,RC,,,outpatient,,,65,32.5,,63.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,52.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,59.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39,90,
SCREW LOCKING 1.7X9MM PIN SELFTAPPING,2000454,CDM,278,RC,,,outpatient,,,200.75,100.38,,194.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,180.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,180.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,137.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,177.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,133.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,162.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,184.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,190.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,194.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,130.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,180.68,
SCREW LOCKING 1.7X10MM PIN SELFTAPPING,2000455,CDM,278,RC,,,outpatient,,,200.75,100.38,,194.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,180.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,180.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,137.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,177.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,133.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,162.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,184.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,190.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,194.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,130.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,180.68,
SCREW LOCKING 1.7X11MM PIN SELFTAPPING,2000456,CDM,278,RC,,,outpatient,,,200.75,100.38,,194.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,180.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,180.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,137.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,177.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,133.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,162.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,184.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,190.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,194.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,130.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,180.68,
PLATE REG 7 H 1.7 S PROFYLE HAND LOCK,2000457,CDM,278,RC,,,outpatient,,,1062.25,531.13,,1030.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,637.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,318.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,956.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,956.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,637.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,772.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,724.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,637.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,857.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,857.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,941.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,704.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,860.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,977.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,1009.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,1030.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,690.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,637.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,637.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,637.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,956.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,637.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,637.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,956.03,
SCREW CROSS PIN SELF TAPPING 1.7X9MM,2000458,CDM,278,RC,,,outpatient,,,165.75,82.88,,160.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,149.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,109.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,134.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,152.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,157.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,160.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,107.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,149.18,
SCREW CROSS PIN SELF TAPPING 1.7X10MM,2000459,CDM,278,RC,,,outpatient,,,165.75,82.88,,160.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,149.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,109.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,134.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,152.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,157.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,160.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,107.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,149.18,
SCREW CROSS PIN SELF TAPPING 1.7X12MM,2000460,CDM,278,RC,,,outpatient,,,165.75,82.88,,160.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,149.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,109.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,134.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,152.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,157.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,160.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,107.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,149.18,
DRILL BIT TWIST 1.4MM DIA AO,2000461,CDM,270,RC,,,outpatient,,,232.25,116.13,,225.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,209.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,158.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,187.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,205.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,153.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,188.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,213.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,220.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,225.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,150.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,209.03,
BIOCOMPSITE PUSHLOCH 4.5X24MM,2000462,CDM,278,RC,,,outpatient,,,868,434,,841.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,520.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,260.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,781.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,781.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,520.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,631.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,592.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,520.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,700.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,700.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,769.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,575.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,703.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,798.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,824.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,841.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,564.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,520.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,520.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,520.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,781.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,520.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,520.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,781.2,
7.7 MM PILOT HEADED REAMER,2000463,CDM,278,RC,,,outpatient,,,444.85,222.43,,431.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,266.91,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.46,30,,,percent of total billed charges,Pays at 30% of total billed charges,400.37,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.37,90,,,percent of total billed charges,Pays at 90% of total billed charges,266.91,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,323.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,303.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,266.91,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,359.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,359.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,394.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,294.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,360.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,409.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,422.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,431.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,289.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,266.91,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,266.91,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,266.91,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.37,90,,,percent of total billed charges,Pays at 90% of total billed charges,266.91,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,266.91,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,400.37,
SUTURE ANCHOR SWIVELOCK TENDESIS,2000464,CDM,278,RC,,,outpatient,,,944,472,,915.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,566.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,283.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,849.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,849.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,566.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,686.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,644.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,566.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,762,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,762,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,836.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,625.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,764.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,868.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,896.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,915.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,613.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,566.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,566.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,566.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,849.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,566.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,566.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,849.6,
COMP RVRS 25mm bsplt ha+adptr,2000465,CDM,278,RC,,,outpatient,,,3255,1627.5,,3157.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,1953,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2929.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,2929.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,1953,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2368.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2221.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1953,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2627.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2627.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2884.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2158.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2636.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2994.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,3092.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,3157.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,2115.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,1953,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1953,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1953,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2929.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,1953,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1953,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2929.5,
HMRL BEARING 36MM +3 PRLNG,2000466,CDM,278,RC,,,outpatient,,,1519,759.5,,1473.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,911.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1367.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,1367.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,911.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1105.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1036.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,911.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1226.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1226.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1345.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1007.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1230.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1397.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,1443.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,1473.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,987.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,911.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,911.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,911.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1367.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,911.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,911.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1367.1,
HMRL TRAY STD STD,2000467,CDM,278,RC,,,outpatient,,,2473.8,1236.9,,2399.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,1484.28,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2226.42,90,,,percent of total billed charges,Pays at 90% of total billed charges,2226.42,90,,,percent of total billed charges,Pays at 90% of total billed charges,1484.28,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1799.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1688.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1484.28,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1996.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1996.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2192.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1640.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2003.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2275.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,2350.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,2399.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,1607.97,65,,,percent of total billed charges,Pays at 65% of total billed charges,1484.28,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1484.28,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1484.28,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2226.42,90,,,percent of total billed charges,Pays at 90% of total billed charges,1484.28,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1484.28,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2226.42,
COMP RVSP SHIDR GLNSP +3 36MM,2000468,CDM,278,RC,,,outpatient,,,2604,1302,,2525.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,1562.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2343.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2343.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,1562.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1894.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1777.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1562.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2101.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2101.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2307.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1726.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2109.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2395.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,2473.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,2525.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,1692.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,1562.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1562.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1562.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2343.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,1562.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1562.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2343.6,
COMP RVS contrl 6.5X25MM ST/RST,2000469,CDM,278,RC,,,outpatient,,,162.75,81.38,,157.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,111.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,131.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,144.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.48,
SCREW COMP LK SCR 3.5 HES,2000470,CDM,278,RC,,,outpatient,,,162.75,81.38,,157.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,111.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,131.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,144.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.48,
SCREW COMP NLK  3.5 HEX 4.75,2000471,CDM,278,RC,,,outpatient,,,162.75,81.38,,157.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,111.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,131.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,144.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.48,
SCREW COMP NLK  3.5 HEX 4.75,2000472,CDM,278,RC,,,outpatient,,,162.75,81.38,,157.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,111.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,131.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,144.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.48,
COMP STEM PRIMARY 11MM,2000473,CDM,278,RC,,,outpatient,,,7378,3689,,7156.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,4426.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,6640.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,6640.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4426.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5368.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5035.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4426.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5955.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5955.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6537.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4891.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5976.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6787.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,7009.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,7156.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,4795.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,4426.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4426.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4426.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6640.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4426.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4426.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,6640.2,
COMP RVS 2.7MM DIA DRL,2000474,CDM,278,RC,,,outpatient,,,289.75,144.88,,281.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,173.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,260.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,260.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,173.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,197.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,173.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,233.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,233.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,256.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,192.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,234.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,266.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,275.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,281.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,188.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,173.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,260.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,173.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,173.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,260.78,
DISP SHORT PUSH LOCK KIT 2.9,2000475,CDM,272,RC,,,outpatient,,,397.75,198.88,,385.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,238.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,357.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,357.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,238.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,289.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,271.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,238.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,321.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,321.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,352.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,263.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,322.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,365.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,377.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,385.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,258.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,238.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,357.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,238.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,238.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,357.98,
SUTURE LASSO 25 TIGHT CURVE RT,2000476,CDM,272,RC,,,outpatient,,,359.5,179.75,,348.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,323.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,323.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,261.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,245.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,290.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,290.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,318.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,238.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,291.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,330.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,341.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,348.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,233.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,323.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,323.55,
SUTURE LASSO 25 TIGHT CURVE LT,2000477,CDM,272,RC,,,outpatient,,,359.5,179.75,,348.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,323.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,323.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,261.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,245.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,290.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,290.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,318.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,238.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,291.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,330.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,341.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,348.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,233.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,323.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,323.55,
PLATE 6 HOLE,2000478,CDM,278,RC,,,outpatient,,,348.75,174.38,,338.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,209.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,313.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,253.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,238.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,209.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,281.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,281.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,309.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,231.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,282.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,320.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,331.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,338.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,226.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,209.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,209.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,313.88,
SCREW CORTEX 3.5X16MM,2000479,CDM,278,RC,,,outpatient,,,65,32.5,,63.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,52.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,59.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39,90,
TRAY THORA-PARA 8FR,2000480,CDM,272,RC,,,outpatient,,,185.25,92.63,,179.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,166.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,126.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,111.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,149.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,164.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,122.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,150.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,170.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,175.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,179.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,120.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,111.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,111.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,166.73,
SCREW CORTEX 3.5X14MM,2000481,CDM,278,RC,,,outpatient,,,90.75,45.38,,88.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,81.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,60.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,73.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,83.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,86.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,88.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.45,90,
PSN fem cr cmt ccr std sz6 r,2000482,CDM,278,RC,,,outpatient,,,4340,2170,,4209.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3906,90,,,percent of total billed charges,Pays at 90% of total billed charges,3906,90,,,percent of total billed charges,Pays at 90% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3157.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2962.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3503.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3503.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3845.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2877.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3515.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3992.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,4123,95,,,percent of total billed charges,Pays at 95% of total billed charges,4209.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,2821,65,,,percent of total billed charges,Pays at 65% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3906,90,,,percent of total billed charges,Pays at 90% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3906,
ALL POLY PAT VE 38MM,2000483,CDM,278,RC,,,outpatient,,,1050,525,,1018.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,630,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,945,90,,,percent of total billed charges,Pays at 90% of total billed charges,945,90,,,percent of total billed charges,Pays at 90% of total billed charges,630,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,763.98,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,716.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,630,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,847.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,847.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,930.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,696.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,850.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,966,92,,,percent of total billed charges,Pays at 92% of total billed charges,997.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,1018.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,682.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,630,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,630,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,630,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,945,90,,,percent of total billed charges,Pays at 90% of total billed charges,630,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,630,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,945,
PSN FEM CR CMT CCR NRW SZ10L,2000484,CDM,278,RC,,,outpatient,,,4340,2170,,4209.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3906,90,,,percent of total billed charges,Pays at 90% of total billed charges,3906,90,,,percent of total billed charges,Pays at 90% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3157.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2962.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3503.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3503.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3845.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2877.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3515.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3992.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,4123,95,,,percent of total billed charges,Pays at 95% of total billed charges,4209.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,2821,65,,,percent of total billed charges,Pays at 65% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3906,90,,,percent of total billed charges,Pays at 90% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3906,
PSN TIB STEM 5 DEG SZL,2000485,CDM,278,RC,,,outpatient,,,1844.5,922.25,,1789.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1660.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1660.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1342.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1258.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1488.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1488.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1634.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1222.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1494.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1696.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,1752.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,1789.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,1198.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1660.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1660.05,
PSN ASF CR 11MM VE L 7-12GH,2000486,CDM,278,RC,,,outpatient,,,2387,1193.5,,2315.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2148.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,2148.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1736.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1629.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1926.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1926.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2115.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1582.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1933.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2196.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,2267.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,2315.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,1551.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2148.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2148.3,
SUTURE 2.0 SILK ENDO STITCH,2000502,CDM,272,RC,,,outpatient,,,112,56,,108.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,100.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,103.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,67.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,100.8,
SUTURE RETENTION BRIDGE,2000503,CDM,272,RC,,,outpatient,,,29.25,14.63,,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,90,
SUTURE  PROLENE 2.0,2000505,CDM,272,RC,,,outpatient,,,202.25,101.13,,196.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,182.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,138.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,121.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,163.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,179.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,134.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,163.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,186.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,192.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,196.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,121.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,121.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,182.03,
SUTURE /GORTEX,2000507,CDM,272,RC,,,outpatient,,,109.75,54.88,,106.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,98.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,74.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,65.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,72.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,88.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,100.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,104.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,106.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,65.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,65.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,98.78,
SUTURE 6.0 FAST ABORBING,2000508,CDM,272,RC,,,outpatient,,,21.25,10.63,,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,90,
SUTURE 5.0 FAST ABORBING,2000509,CDM,272,RC,,,outpatient,,,21,10.5,,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,90,
SUTURE PROLENE 1,2000510,CDM,272,RC,,,outpatient,,,35,17.5,,33.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,21,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,31.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,21,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,21,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,21,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21,90,
SUTURE 2-0 SURGIPRO,2000511,CDM,272,RC,,,outpatient,,,35.5,17.75,,34.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,90,
SUTURE SURGIPRO 3-0 V20 BLUE,2000512,CDM,272,RC,,,outpatient,,,7.5,3.75,,7.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,90,
SUTURE PROLENE 2.0 KS,2000513,CDM,272,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,90,
SUTURE SURGI PRO C17 .0,2000514,CDM,272,RC,,,outpatient,,,12.5,6.25,,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,90,
SUTURE 3-0 SURGIPRO SC2,2000515,CDM,272,RC,,,outpatient,,,14,7,,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,90,
SUTURE 0 TRICRON GS-22,2000516,CDM,272,RC,,,outpatient,,,48.75,24.38,,47.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,43.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,33.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,32.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,39.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,44.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,46.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,47.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,90,
SUTURE 0 TRICRON CT1,2000517,CDM,272,RC,,,outpatient,,,54.75,27.38,,53.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,49.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,32.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,44.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,50.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,52.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,53.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,32.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,32.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.85,90,
SUTURE 0 TRICRON GS-21,2000518,CDM,272,RC,,,outpatient,,,13,6.5,,12.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,90,
SUTURE 0 TRICRON CV-305,2000519,CDM,272,RC,,,outpatient,,,12.75,6.38,,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,
SUTURE 0 TRICRON HGS-22,2000520,CDM,272,RC,,,outpatient,,,20.75,10.38,,20.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,90,
SUTURE TRICRON Y-16 2.0,2000521,CDM,272,RC,,,outpatient,,,24,12,,23.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.4,90,
SUTURE 0 CHROMIC GUT GS-21,2000522,CDM,272,RC,,,outpatient,,,13.5,6.75,,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,
SUTURE 3-0 CHROMIC GUT SH,2000523,CDM,272,RC,,,outpatient,,,41.5,20.75,,40.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,37.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,38.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,39.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,24.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.9,90,
SUTURE 3-0 CHROMIC GUT P12,2000524,CDM,272,RC,,,outpatient,,,14,7,,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,90,
SUTURE 2-0 PLAIN GUT GS21,2000525,CDM,272,RC,,,outpatient,,,12,6,,11.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,
SUTURE 4-0 PLAIN GUT SC11,2000526,CDM,272,RC,,,outpatient,,,14.5,7.25,,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,90,
SUTURE 4-0 PLAIN GUT P13,2000527,CDM,272,RC,,,outpatient,,,26,13,,25.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,23.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.6,90,
SUTURE 4-0 PLAIN GUT SC-1,2000528,CDM,272,RC,,,outpatient,,,42.25,21.13,,40.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,38.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.35,90,
SUTURE 0 POLYSORB REEL,2000529,CDM,272,RC,,,outpatient,,,14.75,7.38,,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,90,
SUTURE 0 VICRYL REEL,2000530,CDM,272,RC,,,outpatient,,,28.75,14.38,,27.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,90,
SUTURE 2-0 VICRYL 54 TIE,2000531,CDM,272,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,
SUTURE 3-0 POLYSORB TIE,2000532,CDM,272,RC,,,outpatient,,,18.25,9.13,,17.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,90,
SUTURE POLYSORB REEL 4.0,2000533,CDM,272,RC,,,outpatient,,,17.25,8.63,,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,90,
SUTURE 0 CHRONIC GUT,2000534,CDM,272,RC,,,outpatient,,,40,20,,38.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,24,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12,30,,,percent of total billed charges,Pays at 30% of total billed charges,36,90,,,percent of total billed charges,Pays at 90% of total billed charges,36,90,,,percent of total billed charges,Pays at 90% of total billed charges,24,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,36.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,38,95,,,percent of total billed charges,Pays at 95% of total billed charges,38.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,26,65,,,percent of total billed charges,Pays at 65% of total billed charges,24,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36,90,,,percent of total billed charges,Pays at 90% of total billed charges,24,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,24,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24,90,
SUTURE 0 POLYSORB GS23,2000535,CDM,272,RC,,,outpatient,,,10.75,5.38,,10.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,90,
SUTURE 0 POLYSORB GS21 POPS,2000536,CDM,272,RC,,,outpatient,,,30.25,15.13,,29.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,27.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,27.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.15,90,
SUTURE 0 POLYSORB GS\22,2000537,CDM,272,RC,,,outpatient,,,8.75,4.38,,8.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,90,
SUTURE  SURGI PRO 6.0 P12,2000538,CDM,272,RC,,,outpatient,,,86.5,43.25,,83.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,57.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,70.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,79.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,82.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.9,90,
SUTURE 0 POLYSORB GS-24,2000539,CDM,272,RC,,,outpatient,,,28.5,14.25,,27.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,90,
SUTURE 1 POLYSORB GS-21,2000540,CDM,272,RC,,,outpatient,,,12.25,6.13,,11.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,90,
SUTURE POLYSORB GS-21 2.0,2000541,CDM,272,RC,,,outpatient,,,6.75,3.38,,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,90,
SUTURE POLYSORB GS-21 2.0,2000542,CDM,272,RC,,,outpatient,,,26.25,13.13,,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,90,
SUTURE 3-0  POLYSORB V20 DYED,2000543,CDM,272,RC,,,outpatient,,,6.25,3.13,,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,90,
SUTURE 3-0 POLYSORB GS23,2000544,CDM,272,RC,,,outpatient,,,8.5,4.25,,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,90,
SUTURE 3-0 VICRYL SH,2000545,CDM,272,RC,,,outpatient,,,51.75,25.88,,50.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,46.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,35.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,41.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,47.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,49.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,50.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.05,90,
SUTURE POLYSORB GS-21 3.0,2000546,CDM,272,RC,,,outpatient,,,7,3.5,,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,90,
SUTURE 4-0 VICRYL CT1,2000547,CDM,272,RC,,,outpatient,,,21,10.5,,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,90,
SUTURE POLYSORB 4.0 V-20,2000548,CDM,272,RC,,,outpatient,,,9.75,4.88,,9.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,90,
SUTURE POLYSORB 4.0 P-12,2000549,CDM,272,RC,,,outpatient,,,12,6,,11.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,
SUTURE POLYSORB GS-21 4.0,2000550,CDM,272,RC,,,outpatient,,,19,9.5,,18.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,90,
SUTURE 4-0 POLYSORB P12,2000551,CDM,272,RC,,,outpatient,,,36.5,18.25,,35.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,33.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,90,
SUTURE 0 SOF SILK,2000552,CDM,272,RC,,,outpatient,,,24,12,,23.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.4,90,
SUTURE  SILK V20,2000553,CDM,272,RC,,,outpatient,,,17,8.5,,16.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,90,
SUTURE 3-0 PERMAHAND SILK SH,2000554,CDM,272,RC,,,outpatient,,,17.5,8.75,,16.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,15.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.5,90,
SUTURE SILK V20 4.0,2000555,CDM,272,RC,,,outpatient,,,22.75,11.38,,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,90,
SUTURE BIOSYN SM-5624,2000556,CDM,272,RC,,,outpatient,,,28.75,14.38,,27.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,90,
SUTURE 1 BIOSYN GS-21,2000557,CDM,272,RC,,,outpatient,,,18.75,9.38,,18.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,90,
SUTURE 4-0 CAPROSYN V20,2000558,CDM,272,RC,,,outpatient,,,39.25,19.63,,38.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,35.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,31.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,36.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,37.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,38.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.55,90,
SUTURE 5-0 CAPROSYN P11,2000559,CDM,272,RC,,,outpatient,,,56.5,28.25,,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,45.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,51.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,53.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,90,
SUTURE 0 MAXON GS22,2000560,CDM,272,RC,,,outpatient,,,50.25,25.13,,48.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,45.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,40.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,46.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,47.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,48.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,90,
SUTURE 0 MAXON GS26,2000561,CDM,272,RC,,,outpatient,,,45.25,22.63,,43.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,40.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,41.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,42.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,43.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.15,90,
SUTURE MAXON GS26-1,2000562,CDM,272,RC,,,outpatient,,,29.5,14.75,,28.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,26.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,27.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.7,90,
SUTURE 3-0 MONOSOF C14,2000563,CDM,272,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,
SUTURE 3-0 MONOSOF P12 SN-5669,2000564,CDM,272,RC,,,outpatient,,,3.5,1.75,,3.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,90,
SUTURE 4-0 MONOSOF C16,2000565,CDM,272,RC,,,outpatient,,,5.75,2.88,,5.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,90,
SUTURE 3-0 ETHILON GSLX,2000566,CDM,272,RC,,,outpatient,,,28,14,,27.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,90,
SUTURE MONOSOF 5-0 BK 18IN,2000567,CDM,272,RC,,,outpatient,,,11.5,5.75,,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,90,
SUTURE 4-0 C-13 MONOSOF,2000568,CDM,272,RC,,,outpatient,,,59.25,29.63,,57.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,53.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,40.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,47.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,39.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,54.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,56.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,57.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.55,90,
SUTURE SOFT SILK,2000569,CDM,272,RC,,,outpatient,,,16.5,8.25,,16.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,90,
SUTURE ETHILON 1671,2000570,CDM,272,RC,,,outpatient,,,8,4,,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,90,
SUTURE MONO 3.0,2000571,CDM,272,RC,,,outpatient,,,17,8.5,,16.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,90,
SUTUREmono 4.0 p 12 SN5667G,2000573,CDM,272,RC,,,outpatient,,,11.25,5.63,,10.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,90,
SUTURE MONOSOF p-12,2000574,CDM,272,RC,,,outpatient,,,18.25,9.13,,17.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,90,
SUTURE surgi pro 4.0,2000575,CDM,272,RC,,,outpatient,,,51,25.5,,49.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,45.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,41.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,46.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,48.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,49.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,30.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,30.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.6,90,
SUTURE POLYSORB 4.0P 12 SL-5627,2000576,CDM,272,RC,,,outpatient,,,11.5,5.75,,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,90,
SUTURE MONOSOF P-12,2000577,CDM,272,RC,,,outpatient,,,11,5.5,,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,90,
SUTURE mono sof 6-0p-10,2000578,CDM,272,RC,,,outpatient,,,11.5,5.75,,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,90,
SUTURE MONOSOF P-10,2000579,CDM,272,RC,,,outpatient,,,18.25,9.13,,17.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,90,
SUTURE POLYSORB 0 GS-21 UNDYED,2000580,CDM,272,RC,,,outpatient,,,12.75,6.38,,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,
SUTURE 18 5-0BLK MONOF,2000581,CDM,272,RC,,,outpatient,,,11,5.5,,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,90,
SUTURE MONSOF 2.0 C-15,2000582,CDM,272,RC,,,outpatient,,,54.25,27.13,,52.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,48.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,43.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,49.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,51.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,52.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.55,90,
SUTURE POLYSORB,2000583,CDM,272,RC,,,outpatient,,,9.75,4.88,,9.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,90,
SUTURE  MONOSOF,2000584,CDM,272,RC,,,outpatient,,,18.5,9.25,,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,90,
SUTURE  MONOSOF,2000585,CDM,272,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,
SUTURE ETHILON 5.0,2000586,CDM,272,RC,,,outpatient,,,28,14,,27.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,90,
SUTURE POLYSORB 4.0 P13,2000587,CDM,272,RC,,,outpatient,,,15.75,7.88,,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,90,
SUTURE VICRYL 5.0,2000588,CDM,272,RC,,,outpatient,,,60.25,30.13,,58.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,41.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,53.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,39.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,48.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,55.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,57.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,58.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,90,
SUTURE  BIOSYN,2000589,CDM,272,RC,,,outpatient,,,28.75,14.38,,27.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,90,
SUTURE VICRYL5-0 BRAIDED18,2000590,CDM,272,RC,,,outpatient,,,60.25,30.13,,58.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,41.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,53.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,39.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,48.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,55.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,57.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,58.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,90,
SUTURE  BIOSYN 3.0 p-12,2000591,CDM,272,RC,,,outpatient,,,45.75,22.88,,44.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,41.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,37.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,42.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,27.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.45,90,
SUTURE  BIOSYN3-0GS-21,2000592,CDM,272,RC,,,outpatient,,,36,18,,34.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,32.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,33.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.6,90,
SUTURE  VLOC 180 2-0 24,2000593,CDM,272,RC,,,outpatient,,,112.5,56.25,,109.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,101.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,103.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,109.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,101.25,
SUTURE ETHILON 6.0,2000594,CDM,272,RC,,,outpatient,,,11.5,5.75,,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,90,
SUTURE  VICRYL 1 CTX COATED,2000595,CDM,272,RC,,,outpatient,,,153.5,76.75,,148.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,92.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,138.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,138.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,104.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,92.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,101.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,124.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,141.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,145.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,148.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,92.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,92.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,138.15,
SUTURE ENDO2-0 8  V-LOC 180 ABSORABLE,2000596,CDM,272,RC,,,outpatient,,,218.25,109.13,,211.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,130.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,196.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,148.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,130.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,176.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,193.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,144.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,176.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,200.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,207.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,211.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,141.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,130.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,130.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,196.43,
SUTURE tricron #2,2000597,CDM,272,RC,,,outpatient,,,90,45,,87.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27,30,,,percent of total billed charges,Pays at 30% of total billed charges,81,90,,,percent of total billed charges,Pays at 90% of total billed charges,81,90,,,percent of total billed charges,Pays at 90% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,72.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,82.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,85.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,87.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,Pays at 90% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54,90,
SUTURE tricron #5,2000598,CDM,272,RC,,,outpatient,,,12.75,6.38,,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,
SUTURE FIBERWIRE 4-0,2000599,CDM,272,RC,,,outpatient,,,105.25,52.63,,102.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,71.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,69.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,85.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,96.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,99.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,102.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,94.73,
SUTURE  POLYSORB 0 UNDYED GS-21,2000600,CDM,272,RC,,,outpatient,,,7.25,3.63,,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,90,
SUTURE  POLYSORB 2-0 GS21 UNDYED,2000601,CDM,272,RC,,,outpatient,,,6.75,3.38,,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,90,
SUTURE  POLYSORB 1 UNDYED GS21,2000602,CDM,272,RC,,,outpatient,,,10,5,,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,30,,,percent of total billed charges,Pays at 30% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,90,
SUTURE  POLYSORB 2 VIOLET V-20,2000603,CDM,272,RC,,,outpatient,,,24.25,12.13,,23.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,90,
BONE PREP KIT,2000604,CDM,272,RC,,,outpatient,,,230.75,115.38,,223.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,138.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,207.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,138.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,157.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,138.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,186.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,204.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,152.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,186.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,212.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,219.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,223.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,149.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,138.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,138.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,138.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,207.68,
SUTURE chromic gut 5.0 p-13,2000605,CDM,272,RC,,,outpatient,,,43.75,21.88,,42.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,39.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,26.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.25,90,
SUTURE CHROMIC GUT 3.0 CV-25,2000606,CDM,272,RC,,,outpatient,,,7.25,3.63,,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,90,
SUTURE POLYSORB 2.0 V20 VIOLET,2000607,CDM,272,RC,,,outpatient,,,27,13.5,,26.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,24.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.2,90,
SUTURE Plain gut 4.0 18IN,2000608,CDM,272,RC,,,outpatient,,,14.75,7.38,,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,90,
SUTURE POLYSORB 2.0 GS-25,2000609,CDM,272,RC,,,outpatient,,,29,14.5,,28.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.4,90,
SUTURE POLYSORB 2.0 V 20,2000610,CDM,272,RC,,,outpatient,,,8.75,4.38,,8.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,90,
SUTURE MAXON,2000611,CDM,272,RC,,,outpatient,,,32.5,16.25,,31.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,29.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,29.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,30.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,31.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.5,90,
BONE WAX,2000612,CDM,272,RC,,,outpatient,,,42,21,,40.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,37.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.02,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,38.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,39.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.2,90,
CANCELLOUS CHIP,2000613,CDM,272,RC,,,outpatient,,,905.75,452.88,,878.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,543.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,815.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,815.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,543.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,659.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,618.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,543.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,731.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,731.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,802.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,600.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,733.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,833.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,860.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,878.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,588.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,543.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,543.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,543.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,815.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,543.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,543.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,815.18,
CANCELLOUS CHIP  B,2000614,CDM,272,RC,,,outpatient,,,1644.5,822.25,,1595.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,986.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,493.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,1480.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1480.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,986.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1196.54,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1122.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,986.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1327.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1327.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1457.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1090.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1332.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1512.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,1562.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,1595.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,1068.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,986.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,986.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,986.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1480.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,986.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,986.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1480.05,
SHAVER 4.0MM,2000615,CDM,272,RC,,,outpatient,,,140.5,70.25,,136.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,126.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,126.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,124.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,113.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,133.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,136.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,126.45,
SHAVER 5.5 MM,2000616,CDM,272,RC,,,outpatient,,,140.5,70.25,,136.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,126.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,126.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,124.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,113.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,133.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,136.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,126.45,
SUTURE SOFSILK 4.0 V-20,2000617,CDM,272,RC,,,outpatient,,,17.5,8.75,,16.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,15.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.5,90,
SUTURE POLYSORB 4.0 P-12,2000618,CDM,272,RC,,,outpatient,,,11.75,5.88,,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,90,
SUTURE monosof 2.0 c-15 BLACK,2000620,CDM,272,RC,,,outpatient,,,11.5,5.75,,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,90,
SUTURE POLYSORB 1 GS-25 VIOLET,2000621,CDM,272,RC,,,outpatient,,,30,15,,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9,30,,,percent of total billed charges,Pays at 30% of total billed charges,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,27.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,90,
K WIRE TROCAR POINT,2000622,CDM,270,RC,,,outpatient,,,64.5,32.25,,62.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,58.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,52.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,59.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,62.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.7,90,
HII MICRO ROD TO ROD CLAMP,2000623,CDM,270,RC,,,outpatient,,,2173.25,1086.63,,2108.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,1303.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,651.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,1955.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1955.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1303.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1581.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1483.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1303.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1754.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1754.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1925.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1440.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1760.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1999.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,2064.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,2108.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,1412.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,1303.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1303.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1303.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1955.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1303.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1303.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1955.93,
HII MICRO PIN CLAMP,2000624,CDM,270,RC,,,outpatient,,,2182.25,1091.13,,2116.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,1309.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,654.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,1964.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,1964.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,1309.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1587.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1489.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1309.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1761.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1761.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1933.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1446.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1767.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2007.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,2073.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,2116.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,1418.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,1309.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1309.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1309.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1964.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,1309.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1309.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1964.03,
HII MICRO 90 DEGREE PIN CLAMP,2000625,CDM,270,RC,,,outpatient,,,2182.25,1091.13,,2116.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,1309.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,654.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,1964.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,1964.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,1309.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1587.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1489.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1309.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1761.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1761.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1933.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1446.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1767.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2007.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,2073.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,2116.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,1418.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,1309.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1309.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1309.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1964.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,1309.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1309.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1964.03,
CARBON CONNECTING ROD,2000626,CDM,270,RC,,,outpatient,,,275.5,137.75,,267.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,165.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,247.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,188.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,165.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,222.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,244.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,223.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,253.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,267.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,179.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,165.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,165.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.95,
APEX S/D HALF PIN 20THR 2X45,2000627,CDM,270,RC,,,outpatient,,,329,164.5,,319.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,197.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,296.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,296.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,197.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,239.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,224.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,197.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,265.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,265.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,291.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,218.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,266.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,302.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,312.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,319.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,197.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,296.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,197.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,197.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,296.1,
SUTURE ticron 5 blue c-20,2000628,CDM,272,RC,,,outpatient,,,13.5,6.75,,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,
SUTURE POLYSORB 1-0 GS-21,2000629,CDM,272,RC,,,outpatient,,,10.75,5.38,,10.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,90,
SUTURE POLYSORB 2-0 GS-21,2000630,CDM,272,RC,,,outpatient,,,7.5,3.75,,7.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,90,
SUTURE POLYSORB 2-0 GS-22,2000631,CDM,272,RC,,,outpatient,,,8.5,4.25,,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,90,
SUTURE POLYSORB 1 GS-22,2000632,CDM,272,RC,,,outpatient,,,12,6,,11.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,
SUTURE POLYSORB 4-0,2000633,CDM,272,RC,,,outpatient,,,12,6,,11.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,
SUTURE POLYSORB 4-0 V-20,2000634,CDM,272,RC,,,outpatient,,,7.5,3.75,,7.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,90,
SUTURE 4. 0 MAXON P-22,2000635,CDM,272,RC,,,outpatient,,,14.25,7.13,,13.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,90,
BONE CEMENT,2000636,CDM,270,RC,,,outpatient,,,529.25,264.63,,513.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,317.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,476.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,476.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,317.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,385.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,361.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,317.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,427.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,427.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,468.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,350.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,428.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,486.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,502.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,513.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,344.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,317.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,317.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,317.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,476.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,317.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,317.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,476.33,
SUTURE  SURGILON 4 T-31 BLK,2000637,CDM,272,RC,,,outpatient,,,6,3,,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,
SUTURE  SURGILON 4-0 WHITE 9-12,2000638,CDM,272,RC,,,outpatient,,,12,6,,11.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,
SUTURE MONO SOF DERMALON 8-0,2000639,CDM,272,RC,,,outpatient,,,77,38.5,,74.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,51.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,62.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,73.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.2,90,
SUTURE POLYSORB 3.0 V-20,2000640,CDM,272,RC,,,outpatient,,,26.25,13.13,,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,90,
SUTURE POLYSORB 2.0 V-20,2000641,CDM,272,RC,,,outpatient,,,27.75,13.88,,26.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,90,
SUTURE POLYSORB 0 V-20,2000642,CDM,272,RC,,,outpatient,,,8.5,4.25,,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,90,
SUTURE CHROMIC GUT,2000643,CDM,272,RC,,,outpatient,,,51,25.5,,49.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,45.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,41.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,46.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,48.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,49.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,30.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,30.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.6,90,
SUTURE TICRON SURGIDAC 5 BLUE,2000644,CDM,272,RC,,,outpatient,,,57.5,28.75,,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,46.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,52.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,54.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,90,
SUTURE MONO SOF 4.0 C-13,2000645,CDM,272,RC,,,outpatient,,,6.25,3.13,,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,90,
SUTURE MONO SOF3.0 C-13,2000646,CDM,272,RC,,,outpatient,,,6.25,3.13,,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,90,
SUTURE MONO SOF 4.0 C-13,2000647,CDM,272,RC,,,outpatient,,,11.5,5.75,,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,90,
SUTURE MONO SOF 5.0 P-12,2000648,CDM,272,RC,,,outpatient,,,11.5,5.75,,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,90,
SUTURE MONO SOF 4.0V-20,2000649,CDM,272,RC,,,outpatient,,,7.5,3.75,,7.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,90,
SWIVEL LOCK BIOCOMPOSIRE,2000650,CDM,272,RC,,,outpatient,,,994,497,,964.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,596.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,298.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,894.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,894.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,596.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,723.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,678.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,596.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,802.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,802.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,880.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,659.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,805.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,914.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,944.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,964.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,646.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,596.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,596.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,596.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,894.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,596.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,596.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,894.6,
MENISCAL  CINCH,2000651,CDM,272,RC,,,outpatient,,,941.5,470.75,,913.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,564.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,282.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,847.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,847.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,564.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,685.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,642.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,564.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,759.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,759.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,834.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,624.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,762.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,866.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,894.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,913.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,611.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,564.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,564.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,564.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,847.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,564.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,564.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,847.35,
SUTURE TENSION,2000652,CDM,272,RC,,,outpatient,,,417.25,208.63,,404.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,250.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,375.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,375.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,303.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,284.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,250.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,336.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,336.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,369.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,276.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,337.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,383.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,396.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,404.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,271.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,250.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,375.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,250.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,375.53,
KNOTLESS ROPE,2000653,CDM,272,RC,,,outpatient,,,2097,1048.5,,2034.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,1258.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,629.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,1887.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1887.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1258.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1525.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1431.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1258.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1692.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1692.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1858.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1390.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1698.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1929.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,1992.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,2034.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,1363.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,1258.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1258.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1258.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1887.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1258.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1258.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1887.3,
SUTURE  monosof c-13 rev/cutting,2000654,CDM,272,RC,,,outpatient,,,6.25,3.13,,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,90,
SUTURE  monosof 3.0 45 cm rev/cutting,2000655,CDM,272,RC,,,outpatient,,,6.25,3.13,,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,90,
SUTURE  monosof 5.0 45 cm rev/cutting,2000656,CDM,272,RC,,,outpatient,,,6.25,3.13,,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,90,
SUTURE  SURGI PRO II 6.0 CV-11,2000657,CDM,272,RC,,,outpatient,,,21.25,10.63,,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,90,
SUTURE POLYSORB GS-21,2000658,CDM,272,RC,,,outpatient,,,21,10.5,,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,90,
SUTURE POLYSORB 4-0 P-13,2000659,CDM,272,RC,,,outpatient,,,23.75,11.88,,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,90,
SUTURE POLYSORB 3-0  CV-23,2000660,CDM,272,RC,,,outpatient,,,23.75,11.88,,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,90,
SUTURE POLYSORB 3-0  P-11,2000661,CDM,272,RC,,,outpatient,,,35,17.5,,33.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,21,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,31.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,21,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,21,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,21,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21,90,
SUTURE  POLYSORB4.0 GL-884,2000662,CDM,272,RC,,,outpatient,,,8.5,4.25,,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,90,
SUTURE  POLYSORB 3.0 UL-215,2000663,CDM,272,RC,,,outpatient,,,8.25,4.13,,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,90,
SUTURE  monosof 3.0 45 cm rev/cutting,2000664,CDM,272,RC,,,outpatient,,,109.5,54.75,,106.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,98.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,74.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,65.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,72.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,88.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,100.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,104.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,106.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,65.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,65.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,98.55,
SUTURE  SOFSILK,2000665,CDM,272,RC,,,outpatient,,,6,3,,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,
PSN TIB 5DEG SZ D R,2000666,CDM,278,RC,,,outpatient,,,1908.75,954.38,,1851.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,1145.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1717.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,1717.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1388.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1302.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1145.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1540.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1540.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1691.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1265.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1546.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1756.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,1813.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,1851.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,1240.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,1145.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1717.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1145.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1717.88,
PSN ASF CR 10MM VE R 3-9 CD,2000667,CDM,278,RC,,,outpatient,,,2470.75,1235.38,,2396.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1797.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1686.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1994.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1994.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2189.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1638.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2001.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2273.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,2347.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,2396.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,1605.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2223.68,
ALL POLY PAT VE 32MM DIA,2000668,CDM,278,RC,,,outpatient,,,1123,561.5,,1089.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1010.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1010.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,817.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,766.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,906.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,906.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,995.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,744.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,909.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1033.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,1066.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,1089.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,729.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1010.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1010.7,
PSN FEM CR CMT CCR STD SZ4 R,2000669,CDM,278,RC,,,outpatient,,,4492,2246,,4357.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3268.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3065.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3625.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3625.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3980.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2978.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3638.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4132.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,4267.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,4357.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,2919.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4042.8,
PSN FEMALE SCREW 2.5MM 25MM,2000670,CDM,278,RC,,,outpatient,,,304.75,152.38,,295.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,274.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,274.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,207.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,245.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,245.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,270.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,202.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,246.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,280.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,289.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,295.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,198.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,274.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,274.28,
SCREW HEX HEAD 3.5X48,2000671,CDM,272,RC,,,outpatient,,,485.25,242.63,,470.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,291.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,436.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,436.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,291.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,353.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,331.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,291.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,391.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,391.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,429.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,321.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,393.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,446.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,460.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,470.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,315.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,291.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,291.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,291.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,436.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,291.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,291.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,436.73,
ARCOS 12X150MM SPL TPR IST,2000672,CDM,278,RC,,,outpatient,,,6780.5,3390.25,,6577.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,4068.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2034.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,6102.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,6102.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,4068.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4933.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4627.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4068.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5473.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5473.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6008.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4495.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5492.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6238.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,6441.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,6577.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,4407.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,4068.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4068.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4068.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6102.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,4068.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4068.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,6102.45,
MOD COCRDIA 22.2MM HD-3MM NK,2000673,CDM,278,RC,,,outpatient,,,1123,561.5,,1089.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,336.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,1010.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1010.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,817.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,766.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,906.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,906.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,995.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,744.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,909.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1033.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,1066.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,1089.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,729.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1010.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1010.7,
CABLE READY CABLE ADDY CERCLAGE,2000674,CDM,278,RC,,,outpatient,,,554.5,277.25,,537.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,332.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,499.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,499.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,332.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,403.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,378.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,332.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,447.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,447.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,491.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,367.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,449.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,510.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,526.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,537.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,360.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,332.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,332.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,332.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,499.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,332.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,332.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,499.05,
ARCO CON SZ A STD 70MM,2000675,CDM,278,RC,,,outpatient,,,13154.75,6577.38,,12760.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,7892.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3946.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,11839.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,11839.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,7892.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9571.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8978.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7892.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10618.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10618.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11656.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8721.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10655.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12102.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,12497.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,12760.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,8550.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,7892.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7892.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7892.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11839.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,7892.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7892.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,11839.28,
BIPOLAR LINER 42/43 ODX22,2000676,CDM,278,RC,,,outpatient,,,449.25,224.63,,435.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,404.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,404.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,326.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,306.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,362.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,362.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,398.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,297.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,363.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,413.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,426.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,435.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,292.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,404.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,404.33,
BIPOLAR SHELL 43MM OD,2000677,CDM,278,RC,,,outpatient,,,674,337,,653.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,606.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,606.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,490.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,460.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,544.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,544.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,597.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,446.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,545.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,620.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,640.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,653.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,438.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,606.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,606.6,
BREATHER MUSCLE TRAINER,2000678,CDM,270,RC,,,outpatient,,,132.5,66.25,,128.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,119.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,90.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,117.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,107.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,121.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,125.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,128.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,119.25,
K WIRE 1.6X27MM,2000679,CDM,272,RC,,,outpatient,,,63,31.5,,61.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,56.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,51.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,57.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,59.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,61.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.8,90,
DRILL BIT 2.2MM,2000680,CDM,272,RC,,,outpatient,,,63,31.5,,61.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,56.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,51.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,57.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,59.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,61.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.8,90,
DRILL BIT 2.9 MM,2000681,CDM,272,RC,,,outpatient,,,135.75,67.88,,131.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,122.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,122.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,92.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,81.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,109.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,90,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,124.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,131.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,81.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,81.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,122.18,
DRILL BIT CALIBRATED 2.2 MM,2000682,CDM,272,RC,,,outpatient,,,229.25,114.63,,222.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,137.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,206.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,206.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,156.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,137.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,185.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,203.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,151.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,185.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,210.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,217.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,222.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,149.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,137.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,137.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,206.33,
DVR LOCK EXTRA LONG LST,2000683,CDM,278,RC,,,outpatient,,,2868,1434,,2781.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,1720.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,860.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,2581.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,2581.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,1720.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2086.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1957.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1720.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2315.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2315.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2541.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1901.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2323.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2638.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,2724.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,2781.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,1864.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,1720.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1720.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1720.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2581.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,1720.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1720.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2581.2,
SCREW LOCKING 3.5X18,2000684,CDM,278,RC,,,outpatient,,,160.5,80.25,,155.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,144.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,144.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,109.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,96.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,129.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,106.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,130.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,147.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,152.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,155.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,96.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,96.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,144.45,
SCREW LOCKING 3.5X16MM,2000685,CDM,278,RC,,,outpatient,,,160.5,80.25,,155.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,144.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,144.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,109.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,96.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,129.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,106.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,130.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,147.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,152.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,155.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,96.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,96.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,144.45,
SCREW PEG SMOOTH 2.2X20MM,2000686,CDM,278,RC,,,outpatient,,,142.75,71.38,,138.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,128.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,97.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,94.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,115.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,131.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,135.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,138.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,92.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,128.48,
SCREW LOCK SQUARE 2.7MMX20MM,2000687,CDM,278,RC,,,outpatient,,,142.75,71.38,,138.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,128.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,97.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,94.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,115.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,131.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,135.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,138.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,92.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,128.48,
SCREW LOCK SQUARE 2.7MMX22MM,2000688,CDM,278,RC,,,outpatient,,,142.75,71.38,,138.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,128.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,97.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,94.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,115.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,131.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,135.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,138.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,92.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,128.48,
LOCK NON LP 2.7MMX16MM,2000689,CDM,278,RC,,,outpatient,,,144,72,,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,116.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,136.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,129.6,
LOCK NON LP 2.7MMX18MM,2000690,CDM,278,RC,,,outpatient,,,144,72,,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,116.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,136.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,129.6,
LOCK NON LP 2.7MMX20MM,2000691,CDM,278,RC,,,outpatient,,,144,72,,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,116.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,136.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,129.6,
PSN MC VE ASF L 11MM  8 11 EF,2000692,CDM,278,RC,,,outpatient,,,2470.75,1235.38,,2396.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1797.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1686.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1994.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1994.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2189.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1638.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2001.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2273.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,2347.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,2396.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,1605.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2223.68,
PSN TIN STM 5 DEGREE SZ EL,2000693,CDM,278,RC,,,outpatient,,,1909.25,954.63,,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1389.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1303.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1691.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1265.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1546.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1756.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,1813.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1241.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1718.33,
PSN FEM CR CMT CCR NRW SZ 8L,2000694,CDM,278,RC,,,outpatient,,,4492,2246,,4357.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3268.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3065.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3625.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3625.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3980.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2978.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3638.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4132.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,4267.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,4357.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,2919.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4042.8,
BIOMET BONE CEMENT R 1X40 US,2000695,CDM,272,RC,,,outpatient,,,234.25,117.13,,227.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,189.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,189.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,207.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,155.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,215.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,222.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,227.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,152.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.83,
SUTURE  POLYSORB 2.0 UL-216,2000696,CDM,272,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,
HUMIDIFIER TUB,2000700,CDM,271,RC,,,outpatient,,,74.75,37.38,,72.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,49.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,60.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,68.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,72.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,90,
DREAMWARE FIT PK,2000701,CDM,272,RC,,,outpatient,,,83.75,41.88,,81.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,75.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,57.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,55.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,67.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,77.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,79.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,81.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.25,90,
MIRAGE FX SAL SLM,2000702,CDM,272,RC,,,outpatient,,,79,39.5,,76.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,53.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,63.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,72.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,76.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.4,90,
MIRAGE FX SAL SLM,2000703,CDM,272,RC,,,outpatient,,,79,39.5,,76.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,53.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,63.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,72.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,76.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.4,90,
ELECTROLASE BLUNT TIP/ STERILE,2000704,CDM,272,RC,,,outpatient,,,19.25,9.63,,18.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,17.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.55,90,
STOCKING ANTI EMBOLISM,2000711,CDM,270,RC,,,outpatient,,,11,5.5,,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,90,
SHOE POST OP ROCKER SM,2000712,CDM,271,RC,,,outpatient,,,84.75,42.38,,82.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,76.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,57.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,68.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,77.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,80.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,82.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,90,
SHOE POST OP ROCKER MED,2000713,CDM,271,RC,,,outpatient,,,84.75,42.38,,82.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,76.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,57.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,68.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,77.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,80.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,82.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,90,
SHOE POST OP LG HEEL WEDGE,2000714,CDM,271,RC,,,outpatient,,,84.75,42.38,,82.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,76.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,57.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,68.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,77.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,80.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,82.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,90,
SHOE POST OP  XLG HEEL ROCKER,2000715,CDM,271,RC,,,outpatient,,,84.75,42.38,,82.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,76.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,57.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,68.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,77.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,80.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,82.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,90,
SHOE HEALING POST OP SM,2000716,CDM,271,RC,,,outpatient,,,75.5,37.75,,73.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,69.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,73.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,90,
SHOE HEALING POST OP MED,2000717,CDM,271,RC,,,outpatient,,,75.5,37.75,,73.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,69.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,73.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,90,
SHOE HEALING ORTHO WEDGE,2000718,CDM,271,RC,,,outpatient,,,112.75,56.38,,109.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,101.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,103.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,107.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,109.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,101.48,
SHOE HEALING POST OP XLG,2000719,CDM,271,RC,,,outpatient,,,75.5,37.75,,73.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,69.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,73.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,90,
TRIATHLON PS FEM,2000720,CDM,278,RC,,,outpatient,,,5528.75,2764.38,,5362.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,3317.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1658.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,4975.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,4975.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,3317.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4022.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3773.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3317.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4462.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4462.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4899.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3665.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4478.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5086.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,5252.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,5362.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,3593.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,3317.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3317.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3317.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4975.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,3317.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3317.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4975.88,
TRIATHLON PIM TIB,2000721,CDM,278,RC,,,outpatient,,,3267.75,1633.88,,3169.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,1960.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,980.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,2940.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,2940.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,1960.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2377.61,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2230.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1960.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2637.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2637.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2895.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2166.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2646.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3006.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,3104.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,3169.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,2124.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,1960.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1960.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1960.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2940.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,1960.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1960.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2940.98,
TRIATHLON PS X3 TIB INSERT,2000722,CDM,278,RC,,,outpatient,,,3808.5,1904.25,,3694.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,2285.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1142.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,3427.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,3427.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2285.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2771.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2599.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2285.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3074.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3074.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3374.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2525.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3084.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3503.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,3618.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,3694.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,2475.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,2285.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2285.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2285.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3427.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2285.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2285.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3427.65,
TRIATHLON SYMMETIC X3,2000723,CDM,278,RC,,,outpatient,,,1888.75,944.38,,1832.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,1133.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,566.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,1699.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,1699.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,1133.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1374.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1289.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1133.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1524.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1524.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1673.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1252.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1529.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1737.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,1794.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,1832.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,1227.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,1133.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1133.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1133.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1699.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,1133.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1133.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1699.88,
SECUR FIT 127 SZ8,2000724,CDM,278,RC,,,outpatient,,,7783.5,3891.75,,7550,97,,,percent of total billed charges,Pays at 97% of total billed charges,4670.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2335.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,7005.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,7005.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4670.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5663.27,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5312.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4670.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6282.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6282.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6896.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5160.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6304.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7160.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,7394.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,7550,97,,,percent of total billed charges,Pays at 97% of total billed charges,5059.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,4670.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4670.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4670.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7005.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4670.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4670.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,7005.15,
DELTA HEAD BIOLOX V40,2000725,CDM,278,RC,,,outpatient,,,2704.75,1352.38,,2623.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,1622.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,811.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,2434.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,2434.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1622.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1967.98,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1845.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1622.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2183.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2183.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2396.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1793.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2190.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2488.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,2569.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,2623.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,1758.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,1622.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1622.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1622.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2434.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1622.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1622.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2434.28,
TRIDENT II TRITANIUM,2000726,CDM,278,RC,,,outpatient,,,3834.75,1917.38,,3719.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,2300.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1150.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,3451.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,3451.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,2300.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2790.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2617.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2300.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3095.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3095.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3397.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2542.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3106.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3527.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,3643.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,3719.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,2492.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,2300.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2300.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2300.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3451.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,2300.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2300.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3451.28,
SCREW HEX PROFILE LOW 6.5MM,2000727,CDM,278,RC,,,outpatient,,,195,97.5,,189.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,175.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,175.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,133.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,157.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,172.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,129.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,157.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,179.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,185.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,189.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,126.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,175.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,175.5,
SCREW HEX PROFILE LOW 6.5MM,2000728,CDM,278,RC,,,outpatient,,,195,97.5,,189.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,175.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,175.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,133.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,157.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,172.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,129.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,157.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,179.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,185.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,189.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,126.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,175.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,175.5,
KNEE SUPPORT HINGED BRACE,2000729,CDM,271,RC,,,outpatient,,,131.5,65.75,,127.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,118.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,106.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,120.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,124.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,127.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,118.35,
KNEE  BRACE LT UPRIGHT,2000730,CDM,271,RC,,,outpatient,,,1264.75,632.38,,1226.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,758.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,521.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1138.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1138.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,758.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,920.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,863.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,758.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1020.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1020.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1120.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,838.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1024.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1163.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,1201.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,1226.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,822.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,758.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,758.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,758.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1138.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,758.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,758.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1138.28,
TOE IMPLANT 3S,2000731,CDM,278,RC,,,outpatient,,,3412.25,1706.13,,3309.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2047.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1023.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,3071.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,3071.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,2047.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2482.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2328.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2047.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2754.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2754.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3023.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2262.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2763.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3139.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,3241.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,3309.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2217.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,2047.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2047.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2047.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3071.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,2047.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2047.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3071.03,
KNEE  BRACE LT  SINGLE UPRIGHT,2000732,CDM,271,RC,,,outpatient,,,1264.75,632.38,,1226.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,758.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,521.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1138.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1138.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,758.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,920.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,863.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,758.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1020.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1020.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1120.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,838.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1024.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1163.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,1201.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,1226.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,822.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,758.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,758.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,758.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1138.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,758.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,758.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1138.28,
KNEE  BRACE RT  SINGLE UPRIGHT,2000733,CDM,270,RC,,,outpatient,,,1264.75,632.38,,1226.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,758.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,379.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,1138.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1138.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,758.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,920.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,863.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,758.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1020.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1020.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1120.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,838.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1024.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1163.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,1201.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,1226.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,822.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,758.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,758.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,758.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1138.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,758.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,758.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1138.28,
BUR 5.5 OVAL SOLID,2000735,CDM,272,RC,,,outpatient,,,128.5,64.25,,124.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,87.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,85.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,104.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,118.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,122.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,124.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,115.65,
BUR 4.0 round fluted,2000736,CDM,272,RC,,,outpatient,,,192.25,96.13,,186.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,115.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,173.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,173.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,131.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,115.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,170.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,127.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,155.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,176.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,182.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,186.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,115.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,115.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,173.03,
BUR 4.0 round fluted B,2000738,CDM,272,RC,,,outpatient,,,124.75,62.38,,121.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,85.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,82.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,101.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,114.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,118.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,121.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,112.28,
BUR 5.0 ROUND FLUTED  B,2000739,CDM,272,RC,,,outpatient,,,124.75,62.38,,121.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,85.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,82.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,101.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,114.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,118.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,121.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,112.28,
JELCO 20GA IV LONG,2000740,CDM,272,RC,,,outpatient,,,7.5,3.75,,7.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,90,
JELCO 18GA IV long,2000741,CDM,272,RC,,,outpatient,,,8.25,4.13,,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,90,
CONCISE PATULA STABILIZER MED,2000742,CDM,270,RC,,,outpatient,,,154.5,77.25,,149.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,92.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,139.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,105.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,92.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,124.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,102.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,125.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,142.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,146.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,149.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,92.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,92.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,139.05,
FEMORAL HEAD 28MM,2000743,CDM,278,RC,,,outpatient,,,1156.75,578.38,,1122.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,694.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,347.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,1041.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,1041.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,694.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,841.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,789.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,694.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,933.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,933.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1025,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,766.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,936.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1064.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,1098.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,1122.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,751.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,694.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,694.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,694.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1041.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,694.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,694.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1041.08,
BI POLAR RING LOCK,2000744,CDM,278,RC,,,outpatient,,,2082,1041,,2019.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,1249.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,624.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,1873.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1873.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1249.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1514.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1420.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1249.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1680.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1680.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1844.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1380.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1686.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1915.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,1977.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,2019.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,1353.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,1249.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1249.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1249.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1873.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1249.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1249.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1873.8,
STEM AVENIR  STANDARD,2000745,CDM,278,RC,,,outpatient,,,4626.75,2313.38,,4487.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,2776.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1388.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,4164.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4164.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,2776.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3366.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3157.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2776.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3734.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3734.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4099.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3067.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3747.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4256.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,4395.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,4487.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,3007.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,2776.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2776.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2776.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4164.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,2776.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2776.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4164.08,
CANN SCREWDRIVER HEX,2000746,CDM,272,RC,,,outpatient,,,947.75,473.88,,919.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,568.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,284.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,852.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,852.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,568.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,689.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,646.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,568.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,765.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,765.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,839.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,628.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,767.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,871.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,900.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,919.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,616.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,568.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,568.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,568.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,852.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,568.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,568.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,852.98,
LMB SPRING FING EXT ASSIST sm,2000747,CDM,270,RC,,,outpatient,,,62.5,31.25,,60.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,56.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,42.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,50.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,57.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,59.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,60.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.5,90,
LMB SPRING FING EXT ASSIST MED,2000748,CDM,270,RC,,,outpatient,,,62.5,31.25,,60.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,56.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,42.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,50.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,57.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,59.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,60.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.5,90,
LMB SPRING FING EXT ASSIST LG,2000749,CDM,270,RC,,,outpatient,,,62.5,31.25,,60.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,56.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,42.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,50.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,57.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,59.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,60.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.5,90,
ALLY WIRE,2000751,CDM,270,RC,,,outpatient,,,125.25,62.63,,121.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,112.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,85.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,75.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,83.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,101.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,115.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,118.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,121.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,75.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,75.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,112.73,
DRESSING HEMOSTATIC QUIK CLOT 4X4,2000752,CDM,272,RC,,,outpatient,,,96.5,48.25,,93.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,86.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,65.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,63.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,78.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,88.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,91.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,93.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.9,90,
SUTURE  SOFSILK 2-0 V20 BLKACK,2000753,CDM,272,RC,,,outpatient,,,4.75,2.38,,4.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,4.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.85,90,
G7 PPS LTD ACET SHELL 52E,2000754,CDM,278,RC,,,outpatient,,,3123.25,1561.63,,3029.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,1873.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2810.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,2810.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1873.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2272.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2131.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1873.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2521.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2521.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2767.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2070.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2529.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2873.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,2967.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,3029.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,2030.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,1873.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1873.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1873.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2810.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1873.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1873.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2810.93,
DRILL BIT 3.2MMX30MM RNGLC+ACET,2000755,CDM,272,RC,,,outpatient,,,158,79,,153.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,142.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,140,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,145.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,150.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,153.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,142.2,
SCREW G7 6.5MM X20MM,2000756,CDM,278,RC,,,outpatient,,,115.75,57.88,,112.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,104.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,104.18,
SCREW G7 6.5MM X25MM,2000757,CDM,278,RC,,,outpatient,,,115.75,57.88,,112.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,104.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,104.18,
HI WALL LINER E1 36MM E G-7,2000758,CDM,278,RC,,,outpatient,,,2660.25,1330.13,,2580.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,1596.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2394.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,2394.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,1596.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1935.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1815.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1596.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2147.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2147.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2357.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1763.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2154.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2447.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,2527.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,2580.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,1729.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,1596.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1596.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1596.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2394.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,1596.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1596.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2394.23,
ECHO POR FMRL RED NC 11X135MM,2000759,CDM,278,RC,,,outpatient,,,3701.5,1850.75,,3590.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,2220.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3331.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,3331.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,2220.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2693.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2526.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2220.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2987.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2987.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3279.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2454.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2998.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3405.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,3516.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,3590.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,2405.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,2220.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2220.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2220.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3331.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,2220.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2220.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3331.35,
CER OPTION TYPLE 1 TPR SLEVE-3,2000760,CDM,278,RC,,,outpatient,,,231.5,115.75,,224.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,138.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,208.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,208.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,138.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,158,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,138.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,186.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,205.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,153.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,187.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,212.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,219.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,224.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,150.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,138.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,138.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,138.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,208.35,
CER BIOLOXD OPTION HD 36MM,2000761,CDM,278,RC,,,outpatient,,,1503.75,751.88,,1458.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,902.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1353.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,1353.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,902.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1094.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1026.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,902.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1213.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1213.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1332.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,996.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1218.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1383.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,1428.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,1458.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,977.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,902.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,902.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,902.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1353.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,902.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,902.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1353.38,
SUTURE SURGIPRO SP5698G,2000762,CDM,272,RC,,,outpatient,,,14.5,7.25,,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,90,
SUTURE SURGIPRO 4.0 VP557X,2000763,CDM,272,RC,,,outpatient,,,21.25,10.63,,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,90,
SET FUHRMAN PLEURAL DRAIN CATH  8.5X15CM,2000764,CDM,272,RC,,,outpatient,,,258.75,129.38,,250.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,232.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.27,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,176.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,155.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,229.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,171.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,209.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,238.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,245.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,250.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,155.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,155.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,232.88,
PSN FEM PS CMT CCR STD SZ6R,2000765,CDM,278,RC,,,outpatient,,,5941,2970.5,,5762.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,3564.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,5346.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,5346.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,3564.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4322.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4054.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3564.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4795.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4795.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5264.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3938.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4812.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5465.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,5643.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,5762.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,3861.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,3564.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3564.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3564.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5346.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,3564.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3564.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,5346.9,
PSN TIB STM 5 DEG SZ D R,2000766,CDM,278,RC,,,outpatient,,,2588.75,1294.38,,2511.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,1553.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2329.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,2329.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,1553.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1883.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1766.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1553.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2089.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2089.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2293.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1716.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2096.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2381.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,2459.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,2511.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,1682.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,1553.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1553.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1553.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2329.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,1553.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1553.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2329.88,
PSN all poly pat ply  29MM,2000767,CDM,278,RC,,,outpatient,,,1103.75,551.88,,1070.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,662.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,993.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,993.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,662.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,803.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,753.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,662.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,890.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,890.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,978.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,731.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,894.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1015.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,1048.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,1070.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,717.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,662.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,662.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,662.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,993.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,662.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,662.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,993.38,
PSN ASF PS 12MM PLY R-6 9CD,2000768,CDM,278,RC,,,outpatient,,,1804.75,902.38,,1750.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,1082.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1624.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1624.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1082.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1313.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1231.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1082.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1456.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1456.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1599.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1196.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1461.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1660.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,1714.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,1750.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,1173.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,1082.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1082.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1082.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1624.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1082.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1082.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1624.28,
HEADLESS TROCAR DRILL PIN 75MM,2000769,CDM,278,RC,,,outpatient,,,944,472,,915.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,566.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,849.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,849.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,566.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,686.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,644.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,566.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,762,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,762,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,836.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,625.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,764.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,868.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,896.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,915.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,613.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,566.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,566.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,566.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,849.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,566.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,566.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,849.6,
TOE IMPLANT 2S,2000770,CDM,278,RC,,,outpatient,,,3412.25,1706.13,,3309.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2047.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3071.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,3071.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,2047.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2482.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2328.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2047.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2754.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2754.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3023.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2262.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2763.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3139.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,3241.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,3309.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2217.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,2047.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2047.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2047.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3071.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,2047.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2047.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3071.03,
TOE IMPLANT 2S,2000771,CDM,272,RC,,,outpatient,,,190,95,,184.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,114,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57,30,,,percent of total billed charges,Pays at 30% of total billed charges,171,90,,,percent of total billed charges,Pays at 90% of total billed charges,171,90,,,percent of total billed charges,Pays at 90% of total billed charges,114,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,129.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,114,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,153.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,153.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,168.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,125.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,153.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,174.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,180.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,184.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,123.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,114,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171,90,,,percent of total billed charges,Pays at 90% of total billed charges,114,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,114,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,171,
WASHER TI  ASNIS III 6.5MM,2000772,CDM,278,RC,,,outpatient,,,137.25,68.63,,133.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.53,
SCREW G7 6.5MMX15MM,2000773,CDM,270,RC,,,outpatient,,,232,116,,225.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,208.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,208.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,158.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,139.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,187.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,205.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,153.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,187.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,213.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,220.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,225.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,150.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,139.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,139.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,208.8,
ECHO POR FEM RED LAT NC 12X140,2000774,CDM,278,RC,,,outpatient,,,3701.5,1850.75,,3590.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,2220.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3331.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,3331.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,2220.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2693.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2526.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2220.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2987.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2987.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3279.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2454.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2998.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3405.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,3516.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,3590.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,2405.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,2220.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2220.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2220.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3331.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,2220.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2220.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3331.35,
CER BIOLOXD MOD HD 36MM-3NK,2000775,CDM,278,RC,,,outpatient,,,1388,694,,1346.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,832.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1249.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,1249.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,832.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1009.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,947.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,832.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1120.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1120.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1229.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,920.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1124.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1276.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,1318.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,1346.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,902.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,832.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,832.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,832.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1249.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,832.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,832.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1249.2,
SCREW G7 6.5MMX30MM,2000776,CDM,278,RC,,,outpatient,,,1844.5,922.25,,1789.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1660.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1660.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1342.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1258.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1488.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1488.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1634.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1222.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1494.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1696.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,1752.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,1789.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,1198.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1660.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1660.05,
G7 HI WALL E1 LINER 36 MM,2000777,CDM,278,RC,,,outpatient,,,2660.25,1330.13,,2580.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,1596.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2394.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,2394.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,1596.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1935.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1815.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1596.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2147.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2147.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2357.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1763.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2154.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2447.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,2527.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,2580.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,1729.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,1596.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1596.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1596.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2394.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,1596.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1596.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2394.23,
G7 PPS LTD ACET SHELL 50D,2000778,CDM,278,RC,,,outpatient,,,3123.25,1561.63,,3029.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,1873.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2810.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,2810.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1873.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2272.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2131.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1873.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2521.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2521.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2767.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2070.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2529.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2873.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,2967.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,3029.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,2030.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,1873.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1873.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1873.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2810.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1873.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1873.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2810.93,
HM FLOW SENSOR INFANT SINGLE USE,2000779,CDM,271,RC,,,outpatient,,,100,50,,97,97,,,percent of total billed charges,Pays at 97% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30,30,,,percent of total billed charges,Pays at 30% of total billed charges,90,90,,,percent of total billed charges,Pays at 90% of total billed charges,90,90,,,percent of total billed charges,Pays at 90% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,68.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,66.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,92,92,,,percent of total billed charges,Pays at 92% of total billed charges,95,95,,,percent of total billed charges,Pays at 95% of total billed charges,97,97,,,percent of total billed charges,Pays at 97% of total billed charges,65,65,,,percent of total billed charges,Pays at 65% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90,90,,,percent of total billed charges,Pays at 90% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,90,
HM FLOW SENSOR PED ADULT,2000780,CDM,271,RC,,,outpatient,,,86.75,43.38,,84.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,78.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,57.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,70.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,79.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,82.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,84.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,52.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.05,90,
HM C2/C3/EXP VAULVE SET ADULT NEO,2000781,CDM,271,RC,,,outpatient,,,64.5,32.25,,62.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,58.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,52.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,59.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,62.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.7,90,
K WIRE .045  9'',2000782,CDM,270,RC,,,outpatient,,,14.5,7.25,,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,90,
OSTEOBOOST BONE VOID FILLER 5CC,2000783,CDM,278,RC,,,outpatient,,,5667.75,2833.88,,5497.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,3400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,5100.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,5100.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,3400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4123.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3868.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4575.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4575.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5022.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3757.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4590.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5214.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,5384.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,5497.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,3684.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,3400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5100.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,3400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,5100.98,
LONG IL KIT 1/5 TI,2000784,CDM,278,RC,,,outpatient,,,8043.5,4021.75,,7802.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,7239.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,7239.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5852.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5489.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6492.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6492.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7127.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5332.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6515.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7400.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,7641.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,7802.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,5228.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7239.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,7239.15,
PASSPORT BUTTON CANNULA 12MM/3CM,2000785,CDM,278,RC,,,outpatient,,,139,69.5,,134.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,125.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,94.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,112.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,127.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,134.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,125.1,
PASSPORT BUTTON CANNULA 12MM/4CM,2000786,CDM,278,RC,,,outpatient,,,139,69.5,,134.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,125.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,94.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,112.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,127.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,134.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,125.1,
KNOTLESS BIOCOMPOSITE SUTUE BTAK ANCHOR,2000787,CDM,278,RC,,,outpatient,,,983.25,491.63,,953.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,589.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,884.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,884.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,589.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,715.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,671.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,589.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,793.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,793.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,871.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,651.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,796.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,904.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,934.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,953.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,639.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,589.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,884.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,589.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,589.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,884.93,
KNOTLESS BIOCOMPOSITE PERCUTANEOUS INSER,2000788,CDM,278,RC,,,outpatient,,,821.5,410.75,,796.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,492.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,739.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,739.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,492.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,597.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,560.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,492.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,663.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,663.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,727.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,544.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,665.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,755.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,780.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,796.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,533.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,492.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,492.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,492.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,739.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,492.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,492.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,739.35,
FIBERTAPE 2MM,2000789,CDM,278,RC,,,outpatient,,,121.75,60.88,,118.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,98.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,115.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,118.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,109.58,
DECELLULARIZED DERMUS 40MMX70MMX3.0MM,2000790,CDM,278,RC,,,outpatient,,,9131,4565.5,,8857.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,5478.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,8217.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,8217.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,5478.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6643.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6231.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5478.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7370.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7370.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8090.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6053.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7396.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8400.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,8674.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,8857.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,5935.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,5478.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5478.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5478.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8217.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,5478.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5478.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,8217.9,
SCREW FEMALE 2.5MM PSN 2.5MM,2000791,CDM,278,RC,,,outpatient,,,313.75,156.88,,304.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,188.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,282.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,282.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,188.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,214.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,188.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,253.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,253.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,278.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,208.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,254.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,288.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,298.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,304.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,203.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,188.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,282.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,188.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,188.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,282.38,
PSN ASF PS 11MM PLY R3-5CD,2000792,CDM,278,RC,,,outpatient,,,2387,1193.5,,2315.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2148.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,2148.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1736.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1629.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1926.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1926.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2115.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1582.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1933.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2196.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,2267.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,2315.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,1551.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2148.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2148.3,
PSN TIB STM DEG SZ D R,2000793,CDM,278,RC,,,outpatient,,,1966.25,983.13,,1907.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,1179.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1769.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,1769.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1430.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1341.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1179.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1587.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1587.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1742.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1303.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1592.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1808.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,1867.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,1907.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,1278.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,1179.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1769.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1179.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1769.63,
PSN ALL POLY PAT ply 35mm,2000794,CDM,278,RC,,,outpatient,,,1085,542.5,,1052.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,976.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,976.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,789.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,740.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,875.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,875.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,961.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,719.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,878.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,998.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,1030.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,1052.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,705.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,976.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,651,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,976.5,
PSN FEM PS CMT CCR STD SZ4R,2000795,CDM,278,RC,,,outpatient,,,4626.75,2313.38,,4487.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,2776.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4164.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4164.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,2776.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3366.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3157.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2776.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3734.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3734.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4099.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3067.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3747.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4256.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,4395.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,4487.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,3007.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,2776.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2776.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2776.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4164.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,2776.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2776.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4164.08,
SAWBLADE RECIPROCATING ZIMMER,2000796,CDM,272,RC,,,outpatient,,,162.75,81.38,,157.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,111.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,131.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,144.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.48,
SAW BLADE SAGITAL SKINNY,2000797,CDM,272,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
PULSE OX RD SET NEO/ADULT,2000798,CDM,270,RC,,,outpatient,,,51.25,25.63,,49.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,46.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,41.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,47.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,48.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,49.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,30.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,30.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.75,90,
FINGER JOINT IMPLANT FLEXSPAN,2000799,CDM,278,RC,,,outpatient,,,2910.5,1455.25,,2823.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,1746.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2619.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,2619.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,1746.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2117.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1986.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1746.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2349.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2349.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2578.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1929.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2357.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2677.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,2764.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,2823.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,1891.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,1746.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1746.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1746.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2619.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,1746.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1746.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2619.45,
VALVE SET 3PC DISP,2000801,CDM,272,RC,,,outpatient,,,34.25,17.13,,33.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,30.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,31.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,32.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.55,90,
ROD CARBON,2000802,CDM,270,RC,,,outpatient,,,274.5,137.25,,266.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,247.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,181.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,260.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,164.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.05,
PIN HALF,2000803,CDM,272,RC,,,outpatient,,,326.5,163.25,,316.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,195.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,293.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,293.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,195.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,237.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,222.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,195.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,263.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,263.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,289.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,216.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,264.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,300.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,310.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,316.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,212.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,195.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,293.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,195.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,195.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,293.85,
LARYNGOSCOPE MAC 3 TRULITE,2000804,CDM,272,RC,,,outpatient,,,41.75,20.88,,40.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,38.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,39.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.05,90,
LARYNGOSCOPE MAC 4 TRULITE,2000805,CDM,272,RC,,,outpatient,,,41,20.5,,39.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,36.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.6,90,
FIBERGLASS CAST 2'' delta PINK,2000806,CDM,272,RC,,,outpatient,,,8.5,4.25,,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,90,
FIBERGLASS CAST 3'' delta PINK,2000807,CDM,272,RC,,,outpatient,,,8.75,4.38,,8.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,90,
FIBERGLASS CAST 4'' delta PINK,2000808,CDM,272,RC,,,outpatient,,,12.5,6.25,,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,90,
FIBERGLASS CAST2'' delta PURPLE,2000809,CDM,272,RC,,,outpatient,,,8,4,,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,90,
FIBERGLASS CAST 3'' delta PURPLE,2000810,CDM,272,RC,,,outpatient,,,9.75,4.88,,9.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,90,
FIBERGLASS CAST 4'' delta PURPLE,2000811,CDM,272,RC,,,outpatient,,,12.5,6.25,,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,90,
SCREW CAN ti 6mm,2000812,CDM,278,RC,,,outpatient,,,142.5,71.25,,138.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,128.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,97.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,94.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,115.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,131.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,135.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,138.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,92.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,128.25,
PLATE FEMUR,2000813,CDM,278,RC,,,outpatient,,,7139.75,3569.88,,6925.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,4283.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,6425.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,6425.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,4283.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5194.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4872.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4283.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5763.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5763.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6326.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4733.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5783.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6568.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,6782.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,6925.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,4640.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,4283.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4283.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4283.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6425.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,4283.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4283.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,6425.78,
SCREW LOCKING 5MM,2000814,CDM,278,RC,,,outpatient,,,567.5,283.75,,550.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,340.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,510.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,510.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,340.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,412.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,387.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,340.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,458.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,458.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,502.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,376.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,459.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,522.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,539.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,550.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,368.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,340.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,340.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,340.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,510.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,340.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,340.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,510.75,
SCREW LOCKING 5MM,2000815,CDM,278,RC,,,outpatient,,,567.5,283.75,,550.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,340.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,510.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,510.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,340.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,412.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,387.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,340.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,458.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,458.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,502.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,376.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,459.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,522.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,539.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,550.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,368.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,340.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,340.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,340.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,510.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,340.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,340.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,510.75,
DRILL BIT,2000816,CDM,272,RC,,,outpatient,,,866,433,,840.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,519.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,779.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,779.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,519.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,630.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,591.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,519.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,699.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,699.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,767.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,574.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,701.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,796.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,822.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,840.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,562.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,519.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,519.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,519.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,779.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,519.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,519.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,779.4,
PATELLAR FULL LENTH  XL STABILIZER RT,2000817,CDM,271,RC,,,outpatient,,,144,72,,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,116.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,136.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,129.6,
WISP/ CLEAR FRAME,2000818,CDM,272,RC,,,outpatient,,,58.25,29.13,,56.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,52.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,47.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,53.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,55.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,56.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.95,90,
BUR2.0 FLUTED,2000819,CDM,272,RC,,,outpatient,,,198.5,99.25,,192.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,178.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,178.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,135.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,175.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,131.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,160.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,182.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,188.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,192.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,129.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,178.65,
BUR 3.0 FLUTED,2000820,CDM,272,RC,,,outpatient,,,198.5,99.25,,192.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,178.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,178.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,135.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,175.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,131.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,160.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,182.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,188.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,192.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,129.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,178.65,
MICROIL SZ3,2000821,CDM,278,RC,,,outpatient,,,9501,4750.5,,9215.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,5700.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,8550.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,8550.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,5700.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6912.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6484.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5700.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7669.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7669.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8418.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6299.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7695.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8740.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,9025.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,9215.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,6175.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,5700.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5700.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5700.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8550.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,5700.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5700.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,8550.9,
SCREW BUTRESS 2.5X20,2000822,CDM,278,RC,,,outpatient,,,687,343.5,,666.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,412.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,618.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,618.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,412.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,499.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,468.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,412.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,554.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,554.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,608.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,455.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,556.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,632.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,652.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,666.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,446.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,412.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,412.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,412.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,618.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,412.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,412.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,618.3,
SCREW BUTRESS 2.5X18,2000823,CDM,278,RC,,,outpatient,,,687,343.5,,666.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,412.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,618.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,618.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,412.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,499.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,468.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,412.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,554.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,554.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,608.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,455.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,556.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,632.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,652.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,666.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,446.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,412.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,412.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,412.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,618.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,412.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,412.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,618.3,
SCREW CORTICAL 2.7X12,2000824,CDM,278,RC,,,outpatient,,,349.5,174.75,,339.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,314.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,314.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,238.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,282.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,282.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,309.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,231.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,283.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,321.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,332.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,339.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,227.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,314.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,314.55,
K WIRE .062X5,2000825,CDM,272,RC,,,outpatient,,,232,116,,225.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,208.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,208.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,158.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,139.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,187.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,205.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,153.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,187.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,213.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,220.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,225.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,150.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,139.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,139.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,208.8,
DRILL BIT,2000826,CDM,272,RC,,,outpatient,,,743,371.5,,720.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,445.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,668.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,668.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,445.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,540.61,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,507.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,445.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,599.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,599.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,658.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,492.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,601.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,683.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,705.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,720.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,482.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,445.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,445.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,445.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,668.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,445.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,445.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,668.7,
SCREW CORTICAL 2.7X10,2000827,CDM,278,RC,,,outpatient,,,349.5,174.75,,339.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,314.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,314.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,238.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,282.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,282.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,309.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,231.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,283.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,321.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,332.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,339.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,227.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,314.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,314.55,
LONG IL KIT R 1/5 TI,2000828,CDM,278,RC,,,outpatient,,,8043.5,4021.75,,7802.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2413.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,7239.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,7239.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5852.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5489.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6492.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6492.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7127.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5332.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6515.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7400.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,7641.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,7802.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,5228.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7239.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,7239.15,
CASTING TAPE 3'' CAMO,2000829,CDM,270,RC,,,outpatient,,,23.25,11.63,,22.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,20.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.95,90,
HUB CAP /WRIST FUSION PLATE screw cover,2000830,CDM,278,RC,,,outpatient,,,384,192,,372.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,230.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,345.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,345.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,230.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,279.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,262.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,230.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,309.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,309.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,340.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,254.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,311.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,353.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,364.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,372.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,249.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,230.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,230.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,230.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,345.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,230.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,230.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,345.6,
HUB CAP /WRIST FUSION PLATE POST,2000831,CDM,278,RC,,,outpatient,,,409.75,204.88,,397.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,245.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,368.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,368.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,245.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,298.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,279.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,245.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,330.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,330.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,363.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,271.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,331.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,376.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,389.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,397.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,266.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,245.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,245.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,245.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,368.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,245.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,245.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,368.78,
HUB CAP /WRIST FUSION PLATE,2000832,CDM,278,RC,,,outpatient,,,3195.25,1597.63,,3099.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,1917.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,958.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,2875.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,2875.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1917.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2324.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2180.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1917.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2579.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2579.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2831.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2118.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2588.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2939.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,3035.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,3099.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,2076.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,1917.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1917.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1917.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2875.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1917.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1917.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2875.73,
SCREW CRUCIFORM 2.7X12.0 MM,2000833,CDM,278,RC,,,outpatient,,,139,69.5,,134.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,125.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,94.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,112.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,127.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,134.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,125.1,
SCREW CRUCIFORM 2.7X14.0 MM,2000834,CDM,278,RC,,,outpatient,,,139,69.5,,134.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,125.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,94.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,112.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,127.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,134.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,125.1,
SCREW CRUCIFORM 2.7X16.0 MM,2000835,CDM,278,RC,,,outpatient,,,139,69.5,,134.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,125.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,94.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,112.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,127.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,134.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,125.1,
IL TI TROCHANTERIC KIT,2000836,CDM,278,RC,,,outpatient,,,2695.75,1347.88,,2614.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,1617.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,808.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,2426.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,2426.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1617.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1961.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1839.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1617.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2176.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2176.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2388.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1787.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2183.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2480.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,2560.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,2614.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,1752.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,1617.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1617.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1617.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2426.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1617.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1617.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2426.18,
BLOOD PRESSURE CUFF PED,2000837,CDM,272,RC,,,outpatient,,,7,3.5,,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,90,
BLOOD PRESSURE CUFFLG ADULT,2000840,CDM,272,RC,,,outpatient,,,8.25,4.13,,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,90,
MINI 22.0,2000841,CDM,278,RC,,,outpatient,,,1481,740.5,,1436.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,888.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,444.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,1332.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,1332.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,888.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1077.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1010.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,888.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1195.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1195.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1312.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,981.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1199.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1362.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,1406.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,1436.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,962.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,888.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,888.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,888.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1332.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,888.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,888.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1332.9,
MINI ACUTRAK 2 DRILL,2000842,CDM,278,RC,,,outpatient,,,921,460.5,,893.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,552.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,276.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,828.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,828.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,552.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,670.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,628.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,552.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,743.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,743.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,816.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,610.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,746.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,847.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,874.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,893.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,598.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,552.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,552.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,552.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,828.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,552.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,552.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,828.9,
WIRE GUIDE 0.45X6,2000843,CDM,278,RC,,,outpatient,,,102,51,,98.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,91.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,82.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,93.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,91.8,
DRIVER TIP QUICK RELEASE2.0MM,2000844,CDM,278,RC,,,outpatient,,,699,349.5,,678.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,419.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,629.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,629.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,419.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,508.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,477.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,419.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,564.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,564.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,619.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,463.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,566.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,643.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,664.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,678.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,454.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,419.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,419.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,419.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,629.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,419.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,419.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,629.1,
WIRE GUIDE 0.35X5.75,2000845,CDM,278,RC,,,outpatient,,,102,51,,98.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,91.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,82.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,93.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,91.8,
K WIRE  WITH STOP,2000846,CDM,278,RC,,,outpatient,,,163.75,81.88,,158.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,147.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,147.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,111.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,98.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,145.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,108.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,132.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,150.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,155.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,158.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,98.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,98.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,147.38,
LONG IL KIT R1/5 TI,2000847,CDM,278,RC,,,outpatient,,,8043.5,4021.75,,7802.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2413.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,7239.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,7239.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5852.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5489.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6492.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6492.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7127.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5332.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6515.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7400.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,7641.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,7802.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,5228.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7239.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,7239.15,
DISTAL BICEP IMPLANT DEL SYSTEM,2000848,CDM,272,RC,,,outpatient,,,2544.75,1272.38,,2468.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,1526.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,763.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,2290.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,2290.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1526.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1851.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1736.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1526.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2054.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2054.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2254.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1687.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2061.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2341.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,2417.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,2468.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,1654.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,1526.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1526.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1526.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2290.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1526.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1526.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2290.28,
PLATE PROFILE 2.0-I33M,2000849,CDM,278,RC,,,outpatient,,,1318.75,659.38,,1279.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,791.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,395.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,1186.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,1186.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,791.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,959.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,900.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,791.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1064.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1064.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1168.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,874.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1068.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1213.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,1252.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,1279.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,857.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,791.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,791.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,791.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1186.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,791.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,791.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1186.88,
SCREW locking T6 2.0MM,2000850,CDM,278,RC,,,outpatient,,,550.25,275.13,,533.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,495.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,495.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.36,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,375.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,444.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,444.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,487.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,364.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,445.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,506.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,522.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,533.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,357.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,495.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,495.23,
SCREW locking T6 2.0MM ---A,2000851,CDM,278,RC,,,outpatient,,,550.25,275.13,,533.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,495.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,495.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.36,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,375.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,444.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,444.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,487.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,364.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,445.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,506.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,522.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,533.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,357.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,495.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,495.23,
SCREW BONE T6 2.0M -130MM,2000852,CDM,278,RC,,,outpatient,,,304,152,,294.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,273.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,273.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,207.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,182.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,245.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,245.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,269.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,201.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,246.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,279.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,288.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,294.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,197.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,182.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,182.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,273.6,
DRILL AO SCALED 1.6MM/196MNM,2000853,CDM,278,RC,,,outpatient,,,727,363.5,,705.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,436.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,654.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,654.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,436.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,528.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,496.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,436.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,586.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,586.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,644.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,482,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,588.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,668.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,690.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,705.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,472.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,436.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,436.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,436.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,654.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,436.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,436.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,654.3,
B-B TAK,2000854,CDM,272,RC,,,outpatient,,,115.75,57.88,,112.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,104.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,104.18,
DRILL BIT,2000855,CDM,272,RC,,,outpatient,,,183,91.5,,177.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,164.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,124.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,148.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,168.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,173.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,177.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,164.7,
SCREW LO PRO,2000856,CDM,278,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
SCREW LO PRO,2000857,CDM,278,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
SCREW LO PRO LOCK,2000858,CDM,278,RC,,,outpatient,,,266.25,133.13,,258.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,239.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,239.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,181.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,214.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,235.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,176.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,215.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,244.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,252.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,258.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,173.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,239.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,239.63,
SCREW LO PRO LOCK,2000859,CDM,278,RC,,,outpatient,,,266.25,133.13,,258.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,239.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,239.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,181.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,214.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,235.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,176.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,215.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,244.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,252.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,258.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,173.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,239.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,239.63,
SCREW LO PRO LOCK,2000860,CDM,278,RC,,,outpatient,,,266.25,133.13,,258.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,239.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,239.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,181.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,214.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,235.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,176.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,215.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,244.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,252.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,258.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,173.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,239.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,239.63,
TIGHT ROPE K LESS,2000861,CDM,278,RC,,,outpatient,,,3458.5,1729.25,,3354.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,2075.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1037.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,3112.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,3112.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2075.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2516.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2360.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2075.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2791.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2791.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3064.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2292.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2801.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3181.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,3285.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,3354.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,2248.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,2075.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2075.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2075.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3112.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2075.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2075.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3112.65,
DRILL BIT 2.5MM,2000862,CDM,272,RC,,,outpatient,,,196.75,98.38,,190.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,177.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,177.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,134.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,118.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,158.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,130.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,159.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,181.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,186.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,190.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,127.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,118.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,118.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,177.08,
PLATE LOCKING THIRD TUBULAR,2000863,CDM,278,RC,,,outpatient,,,694,347,,673.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,416.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,624.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,624.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,416.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,504.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,473.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,416.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,560.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,560.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,614.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,460.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,562.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,638.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,659.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,673.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,451.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,416.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,416.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,416.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,624.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,416.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,416.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,624.6,
PLATE CLAV FRACTURE,2000864,CDM,278,RC,,,outpatient,,,1966.25,983.13,,1907.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,1179.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1769.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,1769.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1430.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1341.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1179.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1587.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1587.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1742.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1303.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1592.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1808.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,1867.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,1907.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,1278.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,1179.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1769.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1179.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1769.63,
SCREW LO PRO,2000865,CDM,278,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
DRILL BIT 5.5MM,2000866,CDM,272,RC,,,outpatient,,,183,91.5,,177.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,164.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,124.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,148.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,168.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,173.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,177.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,164.7,
SCREW VAL 2.4X16MM,2000867,CDM,278,RC,,,outpatient,,,324,162,,314.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,291.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,291.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,221.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,261.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,261.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,214.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,262.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,298.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,307.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,314.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,210.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,291.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,291.6,
SCREW VAL 2.4X18MM,2000868,CDM,278,RC,,,outpatient,,,324,162,,314.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,291.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,291.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,221.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,261.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,261.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,214.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,262.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,298.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,307.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,314.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,210.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,291.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,291.6,
SCREW VAL 2.4X20MM,2000869,CDM,278,RC,,,outpatient,,,324,162,,314.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,291.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,291.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,221.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,261.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,261.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,214.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,262.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,298.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,307.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,314.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,210.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,291.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,291.6,
SCREW PROFILE LOW 3.5X13MM,2000870,CDM,278,RC,,,outpatient,,,139,69.5,,134.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,125.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,94.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,112.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,127.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,134.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,125.1,
SCREW PROFILE LOW 3.5X12MM,2000871,CDM,278,RC,,,outpatient,,,196.75,98.38,,190.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,177.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,177.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,134.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,118.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,158.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,130.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,159.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,181.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,186.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,190.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,127.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,118.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,118.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,177.08,
DRILL BIT 2.5MM,2000872,CDM,272,RC,,,outpatient,,,157.75,78.88,,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,145.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.98,
DRILL BIT,2000873,CDM,272,RC,,,outpatient,,,183,91.5,,177.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,164.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,124.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,148.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,168.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,173.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,177.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,164.7,
PLATE RAD VOLAR DISATL,2000874,CDM,278,RC,,,outpatient,,,1839.25,919.63,,1784.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,1103.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1655.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1655.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1103.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1338.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1255.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1103.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1484.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1484.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1629.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1219.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1489.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1692.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,1747.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,1784.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,1195.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,1103.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1103.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1103.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1655.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1103.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1103.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1655.33,
GUIDE WIRE,2000875,CDM,272,RC,,,outpatient,,,183,91.5,,177.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,164.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,124.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,148.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,168.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,173.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,177.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,164.7,
WIRE CERCLAGE 18 GA,2000876,CDM,278,RC,,,outpatient,,,139,69.5,,134.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,125.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,94.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,112.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,127.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,134.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,125.1,
WIRE CERCLAGE 17 GA,2000877,CDM,278,RC,,,outpatient,,,173.75,86.88,,168.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,156.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,156.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,118.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,104.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,140.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,153.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,115.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,140.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,159.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,165.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,168.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,104.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,156.38,
WIRE CERCLAGE 20 GA,2000878,CDM,278,RC,,,outpatient,,,213.5,106.75,,207.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,192.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,192.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,145.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,172.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,189.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,141.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,172.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,196.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,202.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,207.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,138.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,192.15,
SUTURE  SOFSILK c-14,2000879,CDM,272,RC,,,outpatient,,,20.75,10.38,,20.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,90,
FEM PS CEMENT CCR STD SZ5,2000880,CDM,278,RC,,,outpatient,,,4626.75,2313.38,,4487.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,2776.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4164.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4164.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,2776.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3366.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3157.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2776.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3734.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3734.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4099.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3067.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3747.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4256.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,4395.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,4487.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,3007.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,2776.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2776.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2776.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4164.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,2776.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2776.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4164.08,
PSN TIB STM 5 DEG SZ d r,2000881,CDM,278,RC,,,outpatient,,,1966.25,983.13,,1907.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,1179.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1769.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,1769.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1430.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1341.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1179.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1587.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1587.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1742.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1303.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1592.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1808.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,1867.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,1907.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,1278.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,1179.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1769.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1179.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1769.63,
PSN ASF PS 10MM VE-R-3-5CD,2000882,CDM,278,RC,,,outpatient,,,2544.75,1272.38,,2468.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,1526.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2290.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,2290.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1526.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1851.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1736.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1526.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2054.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2054.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2254.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1687.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2061.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2341.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,2417.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,2468.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,1654.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,1526.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1526.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1526.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2290.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1526.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1526.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2290.28,
ALL POLY PAT VE 35MM DIA,2000883,CDM,278,RC,,,outpatient,,,1156.75,578.38,,1122.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,694.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1041.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,1041.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,694.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,841.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,789.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,694.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,933.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,933.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1025,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,766.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,936.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1064.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,1098.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,1122.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,751.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,694.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,694.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,694.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1041.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,694.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,694.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1041.08,
BLOOD PRESSURE CUFF LONG  ADULT,2000884,CDM,272,RC,,,outpatient,,,14,7,,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,90,
PROMIMAL LATERAL HUMERUS,2000885,CDM,278,RC,,,outpatient,,,5779.5,2889.75,,5606.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,3467.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1733.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,5201.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5201.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,3467.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4205.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3944.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3467.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4665.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4665.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5121.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3831.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4681.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5317.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,5490.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,5606.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,3756.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,3467.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3467.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3467.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5201.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,3467.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3467.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,5201.55,
SCREW LOCKING 4.0MM,2000886,CDM,278,RC,,,outpatient,,,538.25,269.13,,522.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,484.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,484.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,391.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,367.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,434.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,434.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,476.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,356.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,435.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,495.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,511.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,522.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,349.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,484.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,484.43,
SCREW LOCKING 4.0MM,2000887,CDM,278,RC,,,outpatient,,,538.25,269.13,,522.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,484.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,484.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,391.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,367.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,434.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,434.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,476.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,356.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,435.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,495.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,511.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,522.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,349.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,484.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,484.43,
SCREW LOCKING 4.0MM,2000888,CDM,278,RC,,,outpatient,,,538.25,269.13,,522.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,484.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,484.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,391.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,367.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,434.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,434.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,476.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,356.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,435.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,495.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,511.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,522.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,349.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,484.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,484.43,
SCREW LOCKING 4.0MM,2000889,CDM,278,RC,,,outpatient,,,538.25,269.13,,522.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,484.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,484.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,391.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,367.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,434.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,434.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,476.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,356.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,435.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,495.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,511.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,522.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,349.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,484.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,322.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,484.43,
SCREW CORTEX 3.5MM,2000890,CDM,278,RC,,,outpatient,,,223,111.5,,216.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,133.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,200.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,152.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,133.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,180.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,197.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,147.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,180.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,205.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,211.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,216.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,144.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,133.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,133.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,200.7,
SCREW CORTEX 3.5MM,2000891,CDM,278,RC,,,outpatient,,,223,111.5,,216.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,133.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,200.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,152.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,133.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,180.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,197.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,147.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,180.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,205.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,211.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,216.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,144.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,133.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,133.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,200.7,
SCREW G7 6.5MMX20MM,2000892,CDM,278,RC,,,outpatient,,,232,116,,225.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,208.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,208.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,158.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,139.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,187.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,205.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,153.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,187.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,213.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,220.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,225.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,150.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,139.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,139.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,208.8,
DRILL BIT 3.2MMX30MM,2000893,CDM,272,RC,,,outpatient,,,157.75,78.88,,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,145.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.98,
SHELL G7PPS LTD ACET 52E,2000894,CDM,278,RC,,,outpatient,,,3123.25,1561.63,,3029.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,1873.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2810.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,2810.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1873.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2272.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2131.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1873.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2521.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2521.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2767.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2070.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2529.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2873.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,2967.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,3029.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,2030.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,1873.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1873.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1873.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2810.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1873.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1873.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2810.93,
ECHO POR FEM RED LAT NC 13X145,2000895,CDM,278,RC,,,outpatient,,,3701.5,1850.75,,3590.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,2220.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3331.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,3331.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,2220.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2693.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2526.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2220.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2987.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2987.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3279.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2454.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2998.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3405.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,3516.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,3590.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,2405.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,2220.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2220.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2220.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3331.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,2220.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2220.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3331.35,
HI WALL E1 LINER 36MM E,2000896,CDM,278,RC,,,outpatient,,,2660.25,1330.13,,2580.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,1596.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2394.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,2394.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,1596.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1935.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1815.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1596.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2147.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2147.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2357.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1763.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2154.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2447.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,2527.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,2580.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,1729.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,1596.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1596.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1596.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2394.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,1596.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1596.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2394.23,
CER BIOLOXD MOD HD 36MM+NK,2000897,CDM,278,RC,,,outpatient,,,1388,694,,1346.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,832.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1249.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,1249.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,832.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1009.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,947.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,832.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1120.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1120.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1229.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,920.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1124.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1276.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,1318.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,1346.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,902.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,832.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,832.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,832.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1249.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,832.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,832.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1249.2,
BIOCUE STD KIT DOMESTIC,2000898,CDM,272,RC,,,outpatient,,,3017,1508.5,,2926.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,1810.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,905.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,2715.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,2715.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1810.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2195.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2059.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1810.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2435.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2435.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2673.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2000.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2443.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2775.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,2866.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,2926.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,1961.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,1810.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1810.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1810.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2715.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1810.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1810.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2715.3,
NO CORKSCREW,2000899,CDM,272,RC,,,outpatient,,,983.25,491.63,,953.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,589.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,294.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,884.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,884.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,589.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,715.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,671.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,589.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,793.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,793.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,871.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,651.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,796.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,904.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,934.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,953.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,639.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,589.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,884.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,589.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,589.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,884.93,
PLATE OLECRANON 4 HOLE,2000900,CDM,278,RC,,,outpatient,,,3414.5,1707.25,,3312.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,2048.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1024.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,3073.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,3073.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,2048.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2484.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2330.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2048.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2756.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2756.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3025.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2263.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2765.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3141.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,3243.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,3312.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,2219.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,2048.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2048.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2048.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3073.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,2048.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2048.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3073.05,
DRILL BIT 3.5MM,2000901,CDM,272,RC,,,outpatient,,,177.5,88.75,,172.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,159.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,121.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,106.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,157.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,117.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,143.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,163.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,168.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,172.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,115.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,106.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,159.75,
SCREW LO PRO LOCK 2.7X14MM,2000902,CDM,278,RC,,,outpatient,,,258.5,129.25,,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,176.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,229.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,171.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,209.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,237.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,245.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,232.65,
SCREW LO PRO LOCK 2.7X16MM,2000903,CDM,278,RC,,,outpatient,,,258.5,129.25,,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,176.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,229.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,171.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,209.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,237.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,245.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,232.65,
SCREW LO PRO LOCK 2.7X18MM,2000904,CDM,278,RC,,,outpatient,,,258.5,129.25,,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,176.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,229.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,171.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,209.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,237.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,245.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,232.65,
SCREW LO PRO TM SS 3.5X14MM CORT,2000905,CDM,278,RC,,,outpatient,,,82.75,41.38,,80.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,67.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,76.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,90,
SCREW LO PRO TM SS 3.5X16MM CORT,2000906,CDM,278,RC,,,outpatient,,,82.75,41.38,,80.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,67.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,76.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,90,
SCREW LO PRO TM SS 3.5X18MM CORT,2000907,CDM,278,RC,,,outpatient,,,82.75,41.38,,80.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,67.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,76.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,90,
SCREW LO PRO TM SS 3.5X28MM CORT,2000908,CDM,278,RC,,,outpatient,,,82.75,41.38,,80.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,67.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,76.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,90,
SCREW LO PRO TM SS 3.5X36MM CORT,2000909,CDM,278,RC,,,outpatient,,,82.75,41.38,,80.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,67.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,76.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,90,
SCREW LO PRO SS 3.5X14MM,2000910,CDM,278,RC,,,outpatient,,,258.5,129.25,,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,176.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,229.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,171.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,209.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,237.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,245.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,232.65,
SCREW LO PRO SS 3.5X26MM,2000911,CDM,278,RC,,,outpatient,,,258.5,129.25,,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,176.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,229.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,171.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,209.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,237.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,245.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,232.65,
SCREW LO PRO SS 3.5X28MM,2000912,CDM,278,RC,,,outpatient,,,258.5,129.25,,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,176.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,229.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,171.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,209.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,237.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,245.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,232.65,
SUTURE 3-0 MONOSOF P12 SN-1693,2000913,CDM,272,RC,,,outpatient,,,11.25,5.63,,10.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,90,
SCREW LO PRO SS 4.0x40mmcann sht thd,2000914,CDM,278,RC,,,outpatient,,,371,185.5,,359.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,333.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,333.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,253.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,299.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,328.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,245.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,300.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,341.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,352.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,359.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,241.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,333.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,333.9,
SCREW LO PRO SS 4.0mm x42 cann sht thd,2000915,CDM,278,RC,,,outpatient,,,371,185.5,,359.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,333.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,333.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,253.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,299.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,328.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,245.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,300.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,341.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,352.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,359.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,241.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,333.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,333.9,
SCREW LO PRO SS 4.0mm x44 cann sht thd,2000916,CDM,278,RC,,,outpatient,,,371,185.5,,359.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,333.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,333.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,253.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,299.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,328.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,245.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,300.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,341.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,352.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,359.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,241.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,333.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,333.9,
SCREW LO PRO SS 4.0mm x50 cann sht thd,2000917,CDM,278,RC,,,outpatient,,,371,185.5,,359.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,333.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,333.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,253.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,299.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,328.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,245.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,300.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,341.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,352.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,359.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,241.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,333.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,333.9,
GUIDE WIRE TROCAR TIP 1.35MM,2000918,CDM,272,RC,,,outpatient,,,90.25,45.13,,87.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,73.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,83.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,85.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,87.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,90,
DRILL BIT 2.5MM CALIBRATED,2000919,CDM,272,RC,,,outpatient,,,191,95.5,,185.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,171.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,171.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,130.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,114.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,169.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,126.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,154.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,175.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,181.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,185.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,114.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,114.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,171.9,
DRILL BIT 2.0MM CALIBRATED,2000920,CDM,272,RC,,,outpatient,,,213.5,106.75,,207.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,192.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,192.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,145.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,172.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,189.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,141.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,172.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,196.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,202.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,207.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,138.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,192.15,
LOCK DISTAL FIBULA PLT SS RT 5H,2000921,CDM,278,RC,,,outpatient,,,1459.75,729.88,,1415.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,875.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,437.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,1313.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,1313.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,875.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1062.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,996.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,875.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1178.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1178.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1293.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,967.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1182.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1342.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,1386.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,1415.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,948.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,875.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,875.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,875.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1313.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,875.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,875.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1313.78,
LOCKING MED HOOK PATED SS 5H,2000922,CDM,278,RC,,,outpatient,,,1853,926.5,,1797.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,1111.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,555.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,1667.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1667.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1111.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1348.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1264.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1111.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1495.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1495.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1641.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1228.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1500.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1704.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,1760.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,1797.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,1204.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,1111.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1111.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1111.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1667.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1111.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1111.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1667.7,
SOF ROL 6,2000923,CDM,272,RC,,,outpatient,,,20.5,10.25,,19.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,18.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,18.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.3,90,
COCR IFIT HEAD 28MM/+8 V40,2000924,CDM,278,RC,,,outpatient,,,1201.25,600.63,,1165.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,720.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1081.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,1081.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,720.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,874.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,819.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,720.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,969.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,969.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1064.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,796.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,973.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1105.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,1141.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,1165.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,780.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,720.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,720.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,720.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1081.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,720.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,720.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1081.13,
REST MOD PROX CONE BODY,2000925,CDM,278,RC,,,outpatient,,,14884.75,7442.38,,14438.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,8930.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,13396.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,13396.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8930.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10830.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10158.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8930.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12014.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12014.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13189.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9868.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12056.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13693.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,14140.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,14438.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,9675.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,8930.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8930.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8930.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13396.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8930.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8930.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,13396.28,
REST MOD CONICAL DISTAL,2000926,CDM,278,RC,,,outpatient,,,10664,5332,,10344.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,6398.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,9597.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,9597.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,6398.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7759.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7278.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6398.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8607.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8607.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9449.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7070.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8637.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9810.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,10130.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,10344.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,6931.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,6398.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6398.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6398.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9597.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,6398.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6398.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,9597.6,
UHR BIPOLAR 28X50MM,2000927,CDM,278,RC,,,outpatient,,,1630,815,,1581.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,978,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1467,90,,,percent of total billed charges,Pays at 90% of total billed charges,1467,90,,,percent of total billed charges,Pays at 90% of total billed charges,978,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1185.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1112.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,978,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1315.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1315.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1444.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1080.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1320.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1499.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,1548.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,1581.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,1059.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,978,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,978,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,978,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1467,90,,,percent of total billed charges,Pays at 90% of total billed charges,978,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,978,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1467,
PLATE RAYHACK KEINBOCK,2000928,CDM,278,RC,,,outpatient,,,4471.75,2235.88,,4337.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,2683.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4024.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,4024.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,2683.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3253.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3051.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2683.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3609.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3609.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3962.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2964.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3622.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4114.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,4248.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,4337.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,2906.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,2683.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2683.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2683.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4024.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,2683.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2683.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4024.58,
SCREW CORT RAYHACK 3.5X14,2000929,CDM,278,RC,,,outpatient,,,330.25,165.13,,320.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,297.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,297.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,240.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,225.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,266.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,266.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,292.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,218.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,267.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,303.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,313.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,320.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,214.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,297.23,
SCREW CORT 3.5X16,2000930,CDM,278,RC,,,outpatient,,,330.25,165.13,,320.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,297.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,297.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,240.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,225.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,266.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,266.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,292.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,218.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,267.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,303.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,313.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,320.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,214.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,297.23,
SCREW CORT 3.5X18,2000931,CDM,278,RC,,,outpatient,,,330.25,165.13,,320.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,297.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,297.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,240.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,225.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,266.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,266.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,292.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,218.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,267.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,303.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,313.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,320.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,214.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,297.23,
SCREW CORT 3.5X20,2000932,CDM,278,RC,,,outpatient,,,330.25,165.13,,320.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,297.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,297.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,240.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,225.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,266.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,266.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,292.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,218.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,267.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,303.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,313.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,320.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,214.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,297.23,
SCREW CORT 2.7X16,2000933,CDM,278,RC,,,outpatient,,,330.25,165.13,,320.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,297.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,297.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,240.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,225.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,266.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,266.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,292.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,218.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,267.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,303.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,313.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,320.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,214.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,297.23,
DRILL BIT 2.0MM,2000934,CDM,272,RC,,,outpatient,,,721.25,360.63,,699.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,432.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,216.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,649.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,649.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,432.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,524.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,492.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,432.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,582.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,582.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,639.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,478.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,584.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,663.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,685.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,699.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,468.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,432.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,432.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,432.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,649.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,432.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,432.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,649.13,
DRILL BIT 2.5MM,2000935,CDM,272,RC,,,outpatient,,,721.25,360.63,,699.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,432.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,216.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,649.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,649.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,432.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,524.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,492.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,432.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,582.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,582.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,639.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,478.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,584.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,663.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,685.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,699.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,468.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,432.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,432.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,432.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,649.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,432.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,432.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,649.13,
DRILL BIT 2.7MM,2000936,CDM,272,RC,,,outpatient,,,721.25,360.63,,699.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,432.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,216.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,649.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,649.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,432.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,524.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,492.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,432.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,582.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,582.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,639.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,478.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,584.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,663.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,685.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,699.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,468.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,432.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,432.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,432.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,649.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,432.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,432.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,649.13,
TAP BONE 2.7MM,2000937,CDM,278,RC,,,outpatient,,,330.25,165.13,,320.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,297.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,297.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,240.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,225.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,266.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,266.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,292.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,218.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,267.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,303.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,313.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,320.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,214.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,297.23,
TAP BONE 3.5 MM,2000938,CDM,278,RC,,,outpatient,,,330.25,165.13,,320.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,297.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,297.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,240.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,225.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,266.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,266.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,292.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,218.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,267.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,303.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,313.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,320.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,214.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,297.23,
BLADE SAW,2000939,CDM,272,RC,,,outpatient,,,258.5,129.25,,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,176.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,229.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,171.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,209.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,237.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,245.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,232.65,
SCREW CORT 3.5X22,2000940,CDM,278,RC,,,outpatient,,,330.25,165.13,,320.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,297.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,297.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,240.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,225.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,266.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,266.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,292.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,218.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,267.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,303.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,313.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,320.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,214.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,198.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,297.23,
Psn fem ps cmt std sz7r,2000941,CDM,278,RC,,,outpatient,,,4492,2246,,4357.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3268.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3065.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3625.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3625.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3980.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2978.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3638.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4132.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,4267.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,4357.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,2919.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4042.8,
Psn tib stm 5 deg sz d r,2000942,CDM,278,RC,,,outpatient,,,1909.25,954.63,,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1389.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1303.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1691.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1265.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1546.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1756.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,1813.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1241.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1718.33,
Psn asf ps 10mm ply 6-9 cd,2000943,CDM,278,RC,,,outpatient,,,1347.75,673.88,,1307.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1212.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,1212.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,980.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,919.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1087.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1087.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1194.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,893.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1091.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1239.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,1280.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,1307.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,876.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1212.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1212.98,
Psn all poly pat ply 32mm,2000944,CDM,278,RC,,,outpatient,,,674,337,,653.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,606.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,606.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,490.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,460.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,544.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,544.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,597.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,446.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,545.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,620.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,640.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,653.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,438.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,606.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,606.6,
UROSTOMY POUCH,2000945,CDM,272,RC,,,outpatient,,,41,20.5,,39.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,36.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.6,90,
TI  TROCHANTERIC IL KIT,2000946,CDM,270,RC,,,outpatient,,,2604.5,1302.25,,2526.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,1562.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,781.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,2344.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,2344.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1562.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1895.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1777.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1562.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2102.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2102.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2307.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1726.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2109.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2396.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,2474.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,2526.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,1692.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,1562.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1562.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1562.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2344.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1562.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1562.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2344.05,
CER BIOLOXD OPTION 36MM,2000947,CDM,278,RC,,,outpatient,,,1460,730,,1416.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,876,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1314,90,,,percent of total billed charges,Pays at 90% of total billed charges,1314,90,,,percent of total billed charges,Pays at 90% of total billed charges,876,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1062.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,996.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,876,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1178.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1178.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1293.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,967.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1182.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1343.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,1387,95,,,percent of total billed charges,Pays at 95% of total billed charges,1416.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,949,65,,,percent of total billed charges,Pays at 65% of total billed charges,876,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,876,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,876,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1314,90,,,percent of total billed charges,Pays at 90% of total billed charges,876,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,876,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1314,
CER  OPTION TYPE 1 BTPR SLEVE-6,2000948,CDM,278,RC,,,outpatient,,,224.75,112.38,,218.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,153.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,181.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,199.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,182.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,206.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,213.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,218.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,202.28,
ECHO POR FEM RED LAT NC 10C130MM,2000949,CDM,278,RC,,,outpatient,,,3593.75,1796.88,,3485.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3234.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,3234.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2614.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2452.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2900.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2900.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3184.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2382.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2910.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3306.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,3414.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,3485.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,2335.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3234.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3234.38,
SCREW G7 6.5 MM X20MM,2000950,CDM,278,RC,,,outpatient,,,112.5,56.25,,109.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,101.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,103.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,109.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,101.25,
G7 HI WALL 31 LINER 36MMD,2000951,CDM,278,RC,,,outpatient,,,2583,1291.5,,2505.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2324.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2324.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1879.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1762.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2085,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2085,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2288.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1712.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2092.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2376.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,2453.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2505.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,1678.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2324.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2324.7,
G7 OSSEOTI 3 HOLE SHELL 50 MM D,2000952,CDM,278,RC,,,outpatient,,,5710.5,2855.25,,5539.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,3426.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,5139.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,5139.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,3426.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4154.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3897.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3426.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4609.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4609.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5060.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3786.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4625.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5253.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,5424.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,5539.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,3711.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,3426.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3426.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3426.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5139.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,3426.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3426.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,5139.45,
DRILL BIT ACET +3.2MMX30MM RNGLC,2000953,CDM,278,RC,,,outpatient,,,153,76.5,,148.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,137.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,104.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,101.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,123.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,140.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,145.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,148.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,137.7,
DRILL BIT ACET +3.2MMX30MM RNGLC,2000954,CDM,278,RC,,,outpatient,,,153,76.5,,148.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,137.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,104.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,101.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,123.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,140.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,145.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,148.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,137.7,
DRILL SCREW BONE B3.2MM,2000955,CDM,278,RC,,,outpatient,,,202.5,101.25,,196.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,182.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,138.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,121.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,163.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,179.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,134.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,164.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,186.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,192.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,196.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,121.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,121.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,182.25,
PATELLAR FULL LENTH  L STABILIZER,2000956,CDM,271,RC,,,outpatient,,,144,72,,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,116.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,136.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,129.6,
VERSA-DIAL 42X24X42,2000958,CDM,278,RC,,,outpatient,,,3144.5,1572.25,,3050.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,1886.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,943.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,2830.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,2830.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1886.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2287.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2146.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1886.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2538.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2538.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2786.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2084.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2547.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2892.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,2987.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,3050.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,2043.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,1886.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1886.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1886.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2830.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1886.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1886.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2830.05,
VERSA-DIAL /COMP TI STD TAPER,2000959,CDM,278,RC,,,outpatient,,,449.25,224.63,,435.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,404.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,404.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,326.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,306.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,362.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,362.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,398.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,297.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,363.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,413.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,426.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,435.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,292.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,404.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,404.33,
SUTURE  VICRYL 1 CTX COATED,2000960,CDM,272,RC,,,outpatient,,,153.5,76.75,,148.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,92.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,138.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,138.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,104.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,92.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,101.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,124.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,141.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,145.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,148.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,92.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,92.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,138.15,
COPR 8MM HUM FRACT STEM PPS,2000961,CDM,278,RC,,,outpatient,,,7636.25,3818.13,,7407.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,4581.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2290.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,6872.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,6872.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,4581.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5556.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5211.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4581.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6163.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6163.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6766.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5062.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6185.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7025.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,7254.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,7407.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,4963.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,4581.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4581.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4581.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6872.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,4581.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4581.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,6872.63,
SCREW LO PRO tm ss 2.7x24mm,2000962,CDM,278,RC,,,outpatient,,,202.75,101.38,,196.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,138.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,163.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,179.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,134.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,164.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,186.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,192.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,196.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,182.48,
RD SET NEO CS-3 3' CABLE,2000963,CDM,270,RC,,,outpatient,,,51.25,25.63,,49.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,46.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,41.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,47.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,48.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,49.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,30.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,30.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.75,90,
SCREW LO PRO tm ss 2.7x20mm,2000964,CDM,278,RC,,,outpatient,,,258.5,129.25,,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,176.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,229.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,171.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,209.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,237.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,245.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,232.65,
SCREW LO PRO tm ss 2.7x22mm,2000965,CDM,278,RC,,,outpatient,,,258.5,129.25,,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,176.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,229.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,171.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,209.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,237.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,245.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,232.65,
SCREW LO PRO TM SS 3.5X55MM,2000968,CDM,278,RC,,,outpatient,,,82.75,41.38,,80.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,67.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,76.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,90,
SCREW LO PROf SS 4.0X45MM,2000971,CDM,278,RC,,,outpatient,,,371,185.5,,359.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,333.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,333.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,253.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,299.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,328.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,245.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,300.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,341.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,352.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,359.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,241.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,333.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,333.9,
SCREW LO PROf SS 4.0X50MM,2000972,CDM,278,RC,,,outpatient,,,371,185.5,,359.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,333.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,333.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,253.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,299.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,328.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,245.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,300.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,341.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,352.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,359.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,241.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,333.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,222.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,333.9,
DRILL BIT 2.6MM CALIBRATED,2000974,CDM,278,RC,,,outpatient,,,393.25,196.63,,381.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,353.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,353.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,286.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,268.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,317.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,317.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,348.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,260.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,318.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,361.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,373.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,381.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,255.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,353.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,353.93,
ALLOSYNC DBM GEL 5CC,2000975,CDM,272,RC,,,outpatient,,,1797,898.5,,1743.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,1078.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,1617.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1617.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1078.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1307.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1226.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1078.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1450.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1450.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1592.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1191.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1455.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1653.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,1707.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,1743.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,1168.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,1078.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1078.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1078.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1617.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1078.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1078.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1617.3,
PATELLAR FULL LENTH  XL STABILIZER LT,2000976,CDM,271,RC,,,outpatient,,,144,72,,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,116.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,136.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,129.6,
DISTAL Lock FIBULA PLATE SS RT 8 HOLE,2000977,CDM,278,RC,,,outpatient,,,1785.75,892.88,,1732.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,1071.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,535.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,1607.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1607.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1071.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1299.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1218.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1071.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1441.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1441.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1582.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1183.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1446.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1642.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,1696.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,1732.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,1160.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,1071.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1071.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1071.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1607.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1071.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1071.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1607.18,
PEEK SUTURE ANCHOR,2000978,CDM,278,RC,,,outpatient,,,4323.5,2161.75,,4193.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,2594.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1297.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,3891.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,3891.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,2594.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3145.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2950.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2594.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3489.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3489.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3831.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2866.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3502.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3977.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,4107.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,4193.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,2810.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,2594.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2594.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2594.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3891.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,2594.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2594.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3891.15,
KNOTLESS SUTURE KIT,2000979,CDM,278,RC,,,outpatient,,,1629,814.5,,1580.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,977.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,488.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,1466.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,1466.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,977.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1185.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1111.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,977.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1314.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1314.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1443.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1080.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1319.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1498.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,1547.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,1580.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,1058.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,977.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,977.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,977.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1466.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,977.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,977.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1466.1,
Plate tibia 8 hole,2000980,CDM,278,RC,,,outpatient,,,9720.75,4860.38,,9429.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,5832.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2916.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,8748.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,8748.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,5832.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7072.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6634.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5832.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7846.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7846.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8613.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6444.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7873.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8943.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,9234.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,9429.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,6318.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,5832.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5832.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5832.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8748.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,5832.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5832.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,8748.68,
LOCKING SCREW 4x i20MM,2000981,CDM,278,RC,,,outpatient,,,522.5,261.25,,506.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,470.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,470.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,380.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,356.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,421.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,462.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,346.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,423.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,480.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,496.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,506.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,339.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,470.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,470.25,
LOCKING SCREW 4Xi22MM,2000982,CDM,278,RC,,,outpatient,,,522.5,261.25,,506.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,470.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,470.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,380.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,356.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,421.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,462.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,346.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,423.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,480.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,496.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,506.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,339.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,470.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,470.25,
LOCKING SCREW 4Xi32MM,2000983,CDM,278,RC,,,outpatient,,,522.5,261.25,,506.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,470.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,470.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,380.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,356.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,421.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,462.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,346.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,423.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,480.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,496.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,506.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,339.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,470.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,470.25,
LOCKING SCREW 4Xi34MM,2000984,CDM,278,RC,,,outpatient,,,522.5,261.25,,506.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,470.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,470.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,380.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,356.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,421.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,462.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,346.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,423.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,480.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,496.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,506.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,339.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,470.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,313.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,470.25,
SCREW cortex3.5Xi20MM,2000985,CDM,278,RC,,,outpatient,,,116.5,58.25,,113.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,104.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,107.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,104.85,
SCREW cortex3.5Xi28MM,2000986,CDM,278,RC,,,outpatient,,,116.5,58.25,,113.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,104.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,107.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,104.85,
SCREW cortex3.5Xi40MM,2000987,CDM,278,RC,,,outpatient,,,116.5,58.25,,113.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,104.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,107.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,104.85,
DISK SPIKED,2000992,CDM,278,RC,,,outpatient,,,1959.5,979.75,,1900.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,1175.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,587.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,1763.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,1763.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,1175.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1425.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1337.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1175.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1581.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1581.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1736.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1299.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1587.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1802.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,1861.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,1900.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,1273.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,1175.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1175.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1175.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1763.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,1175.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1175.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1763.55,
PIN FIXATION,2000993,CDM,278,RC,,,outpatient,,,455,227.5,,441.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,409.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,409.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,331.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,310.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,367.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,367.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,403.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,301.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,368.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,418.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,432.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,441.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,295.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,409.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,409.5,
SCREW LO PRO LOCK 2.7X18MM,2000994,CDM,278,RC,,,outpatient,,,202.75,101.38,,196.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,138.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,163.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,179.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,134.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,164.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,186.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,192.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,196.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,182.48,
SCREW LO PRO LOCK 2.7X22MM,2000995,CDM,278,RC,,,outpatient,,,202.75,101.38,,196.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,138.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,163.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,179.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,134.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,164.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,186.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,192.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,196.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,182.48,
SCREW LO PRO LOCK 3.5X38MM,2000996,CDM,278,RC,,,outpatient,,,157.75,78.88,,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,145.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.98,
SCREW LO PRO LOCK 3.5X42MM,2000997,CDM,278,RC,,,outpatient,,,157.75,78.88,,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,145.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.98,
SCREW LO PRO LOCK 3.5X44MM,2000998,CDM,278,RC,,,outpatient,,,157.75,78.88,,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,145.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.98,
SCREW LO PRO LOCK 4.0X16MM,2000999,CDM,278,RC,,,outpatient,,,157.75,78.88,,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,145.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.98,
KIT /TROCAR SINGLE PUNC,2001000,CDM,272,RC,,,outpatient,,,261.5,130.75,,253.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,156.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,235.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,235.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,156.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.27,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,178.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,156.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,211.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,211.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,231.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,173.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,211.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,240.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,248.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,253.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,169.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,156.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,156.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,156.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,235.35,
HAMMER /TOE IMPLANT,2001003,CDM,272,RC,,,outpatient,,,1361.75,680.88,,1320.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,817.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,408.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,1225.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1225.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,817.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,990.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,929.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,817.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1099.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1099.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1206.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,902.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1103.02,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1252.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,1293.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,1320.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,885.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,817.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,817.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,817.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1225.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,817.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,817.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1225.58,
IRRIG ST WATER 1500ML,2001004,CDM,270,RC,,,outpatient,,,9.5,4.75,,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,90,
HAMMER /TOE KIT,2001005,CDM,272,RC,,,outpatient,,,1921,960.5,,1863.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,1152.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,576.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,1728.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,1728.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,1152.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1397.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1311.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1152.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1550.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1550.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1702.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1273.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1556.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1767.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,1824.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,1863.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,1248.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,1152.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1152.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1152.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1728.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,1152.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1152.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1728.9,
IRRIG ST WATER 1000ML,2001006,CDM,270,RC,,,outpatient,,,8.5,4.25,,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,90,
IRRIG ST WATER 500ML,2001007,CDM,272,RC,,,outpatient,,,7.25,3.63,,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,90,
IRRIG 9% SOD CHL 1000ML,2001008,CDM,270,RC,,,outpatient,,,8.5,4.25,,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,90,
IRRIG STERILE WATER 250ML,2001009,CDM,270,RC,,,outpatient,,,8,4,,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,90,
IRRIG 9% SOD CHL 500ML,2001010,CDM,270,RC,,,outpatient,,,5.75,2.88,,5.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,90,
IRRIG 9% SOD CHL 250ML,2001011,CDM,270,RC,,,outpatient,,,7.25,3.63,,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,90,
PENROSE DRAIN 1X36,2001012,CDM,272,RC,,,outpatient,,,8.25,4.13,,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,90,
HOLLISTER COLLECTOR,2001014,CDM,272,RC,,,outpatient,,,42.25,21.13,,40.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,38.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.35,90,
COLOSTOMY CUT TO FIT BAG,2001015,CDM,272,RC,,,outpatient,,,20.25,10.13,,19.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,18.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.15,90,
SLIT KNIFE 3.0 ANGLE,2001016,CDM,272,RC,,,outpatient,,,114,57,,110.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,102.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,102.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,75.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,92.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,104.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,108.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,110.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.6,
CHEMOSITE SYSTEM,2001017,CDM,271,RC,,,outpatient,,,2481.75,1240.88,,2407.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,1489.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,744.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,2233.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,2233.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1489.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1805.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1693.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1489.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2003.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2003.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2199.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1645.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2010.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2283.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,2357.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,2407.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,1613.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,1489.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1489.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1489.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2233.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1489.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1489.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2233.58,
GAUZE RAYTECS 4X8,2001018,CDM,271,RC,,,outpatient,,,40.75,20.38,,39.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.45,90,
DISP LOOP ELEX 20MMX10MM,2001020,CDM,272,RC,,,outpatient,,,138.5,69.25,,134.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,124.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,124.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,94.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,111.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,122.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,112.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,127.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,131.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,134.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,83.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,124.65,
DRESSING BIOCLUSIVE 4,2001021,CDM,272,RC,,,outpatient,,,4.5,2.25,,4.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.27,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,4.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,
DRAIN POUCH COOK VPI,2001022,CDM,272,RC,,,outpatient,,,140,70,,135.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42,30,,,percent of total billed charges,Pays at 30% of total billed charges,126,90,,,percent of total billed charges,Pays at 90% of total billed charges,126,90,,,percent of total billed charges,Pays at 90% of total billed charges,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,124.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,113.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,128.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,133,95,,,percent of total billed charges,Pays at 95% of total billed charges,135.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,91,65,,,percent of total billed charges,Pays at 65% of total billed charges,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126,90,,,percent of total billed charges,Pays at 90% of total billed charges,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,126,
DRESSING ATS VAC,2001024,CDM,272,RC,,,outpatient,,,806.25,403.13,,782.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,483.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,241.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,725.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,725.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,483.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,586.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,550.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,483.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,650.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,650.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,714.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,534.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,653.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,741.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,765.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,782.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,524.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,483.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,483.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,483.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,725.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,483.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,483.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,725.63,
DRESSING CURASALT 6X6,2001025,CDM,272,RC,,,outpatient,,,11,5.5,,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,90,
SURGICEL 4X8,2001026,CDM,272,RC,,,outpatient,,,241.25,120.63,,234.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,144.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,217.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,217.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,144.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,175.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,164.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,144.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,194.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,213.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,159.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,195.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,221.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,229.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,234.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,156.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,144.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,217.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,144.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,144.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,217.13,
DRESSING FLEXIGEL 4 X 4,2001027,CDM,272,RC,,,outpatient,,,21,10.5,,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,90,
PAR-THOROCENTESIS TRAY,2001028,CDM,272,RC,,,outpatient,,,95.75,47.88,,92.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,86.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,65.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,63.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,77.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,88.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,90.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,92.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,57.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,57.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.45,90,
DRESSING ALGICELL 4X4,2001029,CDM,272,RC,,,outpatient,,,15.5,7.75,,15.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,90,
CATHETER TRIPLE LUMN CVP 20CM,2001031,CDM,270,RC,,,outpatient,,,187.5,93.75,,181.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,168.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,127.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,151.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,166.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,124.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,151.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,172.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,178.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,181.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,168.75,
CATHETER TRIPLE LUMN CVP16CM,2001032,CDM,270,RC,,,outpatient,,,221.25,110.63,,214.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,132.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,199.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,199.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.98,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,151,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,132.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,178.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,196.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,146.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,179.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,203.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,210.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,214.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,143.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,132.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,132.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,199.13,
CATHETER 22fr 30 cc couvelaire,2001033,CDM,272,RC,,,outpatient,,,105.75,52.88,,102.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,95.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,72.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,85.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,97.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,100.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,102.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,63.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,95.18,
CATHETER BARTHOLIN GLAND,2001035,CDM,270,RC,,,outpatient,,,99.25,49.63,,96.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,89.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,80.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,91.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,94.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,96.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,90,
ENDO CLIP 10MM,2001036,CDM,272,RC,,,outpatient,,,311,155.5,,301.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,186.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,279.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,279.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,186.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,212.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,186.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,251.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,275.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,206.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,251.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,286.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,295.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,301.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,202.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,186.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,279.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,186.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,186.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,279.9,
ENDO CLIP 10MM USSG,2001037,CDM,272,RC,,,outpatient,,,229.25,114.63,,222.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,137.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,206.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,206.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,156.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,137.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,185.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,203.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,151.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,185.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,210.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,217.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,222.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,149.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,137.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,137.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,206.33,
BIS QUATRO ELECTRODE,2001038,CDM,271,RC,,,outpatient,,,107.75,53.88,,104.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,96.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,95.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,71.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,87.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,99.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,102.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,104.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,96.98,
DRAIGE DEPOT,2001041,CDM,272,RC,,,outpatient,,,69,34.5,,66.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,62.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,45.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,55.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,63.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,65.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,66.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.4,90,
NEEDLE POSTIONING GRID,2001042,CDM,272,RC,,,outpatient,,,32.5,16.25,,31.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,29.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,29.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,30.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,31.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.5,90,
SABER SHAVER 3.5mm X 7cm,2001043,CDM,272,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
RELOAD 30.25,2001044,CDM,272,RC,,,outpatient,,,306,153,,296.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,183.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,275.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,275.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,183.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,208.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,183.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,247,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,271.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,202.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,247.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,281.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,290.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,296.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,198.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,183.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,275.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,183.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,183.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,275.4,
RELOAD GIA 45-2.0,2001045,CDM,272,RC,,,outpatient,,,318,159,,308.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,190.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,286.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,286.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,190.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,231.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,217.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,190.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,256.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,256.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,281.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,210.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,257.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,292.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,302.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,308.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,206.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,190.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,286.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,190.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,190.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,286.2,
RELOAD 45-2.5,2001046,CDM,272,RC,,,outpatient,,,248.5,124.25,,241.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,149.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,223.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,223.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,169.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,149.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,220.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,164.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,201.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,228.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,236.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,241.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,161.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,149.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,149.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,223.65,
RELOADS 45 BLUE,2001047,CDM,272,RC,,,outpatient,,,267.75,133.88,,259.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,160.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,240.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,240.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,160.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,182.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,160.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,216.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,216.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,237.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,177.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,216.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,246.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,254.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,259.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,174.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,160.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,240.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,160.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,160.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,240.98,
ENDO GIA 12MM 45,2001048,CDM,272,RC,,,outpatient,,,1901.75,950.88,,1844.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,1141.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,570.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,1711.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1711.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1141.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1383.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1297.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1141.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1535.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1535.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1685.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1260.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1540.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1749.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,1806.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,1844.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,1236.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,1141.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1141.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1141.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1711.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1141.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1141.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1711.58,
ENDO GIA 12MM 35,2001049,CDM,272,RC,,,outpatient,,,2494,1247,,2419.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,1496.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,748.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,2244.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2244.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,1496.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1814.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1702.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1496.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2013.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2013.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2209.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1653.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2020.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2294.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,2369.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,2419.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,1621.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,1496.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1496.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1496.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2244.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,1496.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1496.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2244.6,
CATHETER VENUS,2001051,CDM,272,RC,,,outpatient,,,2201,1100.5,,2134.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1320.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,660.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,1980.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,1980.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,1320.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1601.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1502.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1320.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1776.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1776.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1950.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1459.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1782.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2024.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,2090.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,2134.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1430.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,1320.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1320.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1320.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1980.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,1320.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1320.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1980.9,
SUTURE MAXON 3.0 P12 CLEAR,2001052,CDM,272,RC,,,outpatient,,,13.5,6.75,,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,
RELOADS 35 BLUE,2001053,CDM,272,RC,,,outpatient,,,232.75,116.38,,225.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,209.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,158.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,139.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,187.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,188.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,214.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,221.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,225.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,139.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,139.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,209.48,
ENDO CLIP 5MM,2001056,CDM,272,RC,,,outpatient,,,364,182,,353.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,218.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,327.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,327.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,218.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,264.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,248.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,218.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,293.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,293.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,322.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,241.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,294.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,334.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,345.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,353.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,236.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,218.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,327.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,218.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,218.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,327.6,
ENDO SLEEVES,2001057,CDM,272,RC,,,outpatient,,,128.5,64.25,,124.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,87.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,85.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,104.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,118.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,122.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,124.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,115.65,
FILSHIE CLIPS,2001058,CDM,272,RC,,,outpatient,,,495.25,247.63,,480.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,297.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,445.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,445.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,297.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,360.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,338.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,297.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,399.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,399.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,438.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,328.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,401.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,455.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,470.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,480.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,321.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,297.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,445.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,297.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,297.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,445.73,
MICRO INTRODUCER 7FR,2001059,CDM,272,RC,,,outpatient,,,144.25,72.13,,139.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,129.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,129.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,116.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,139.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,129.83,
VERSASTEP 5MM,2001062,CDM,272,RC,,,outpatient,,,199.5,99.75,,193.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,179.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,179.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,136.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,161.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,176.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,132.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,161.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,183.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,189.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,193.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,129.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,179.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,179.55,
VERSASTEP 14MM SHORT,2001063,CDM,272,RC,,,outpatient,,,83.75,41.88,,81.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,75.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,57.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,55.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,67.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,77.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,79.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,81.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.25,90,
ENDOPATH 11MM RIBBED,2001064,CDM,272,RC,,,outpatient,,,844.75,422.38,,819.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,506.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,253.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,760.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,760.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,506.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,614.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,576.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,506.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,681.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,681.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,748.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,560.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,684.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,777.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,802.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,819.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,549.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,506.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,506.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,506.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,760.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,506.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,506.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,760.28,
VERSASTEP 14MMLONG,2001065,CDM,272,RC,,,outpatient,,,174,87,,168.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,156.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,156.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,118.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,104.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,140.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,115.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,140.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,160.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,165.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,168.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,104.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,156.6,
CLOSER FAST  LT,2001067,CDM,272,RC,,,outpatient,,,130,65,,126.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,78,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39,30,,,percent of total billed charges,Pays at 30% of total billed charges,117,90,,,percent of total billed charges,Pays at 90% of total billed charges,117,90,,,percent of total billed charges,Pays at 90% of total billed charges,78,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,88.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,104.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,105.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,119.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,123.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,78,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117,90,,,percent of total billed charges,Pays at 90% of total billed charges,78,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,78,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117,
FETAL SCALP ELECTRODESPI,2001068,CDM,272,RC,,,outpatient,,,18.5,9.25,,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,90,
DISP LIFT PAD,2001069,CDM,271,RC,,,outpatient,,,227.75,113.88,,220.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,136.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,204.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,204.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,155.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,136.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,183.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,201.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,151,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,184.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,209.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,216.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,220.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,148.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,136.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,204.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,136.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,204.98,
IPC (INTRA PRES CATH),2001070,CDM,271,RC,,,outpatient,,,14.75,7.38,,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,90,
TROCAR CORE 5MM SMOOTH,2001071,CDM,270,RC,,,outpatient,,,159.5,79.75,,154.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,143.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,143.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,108.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,95.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,105.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,129.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,146.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,151.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,154.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,95.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,95.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,143.55,
SUTURE NYLON  10-0,2001072,CDM,272,RC,,,outpatient,,,172.5,86.25,,167.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,155.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,117.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,139.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,158.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,163.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,167.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,155.25,
8MM TROCAR SMOOTH,2001073,CDM,272,RC,,,outpatient,,,139.25,69.63,,135.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,125.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,112.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,128.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,135.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,83.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,125.33,
ENDOPATH 11MM SMOOTH,2001075,CDM,272,RC,,,outpatient,,,412.75,206.38,,400.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,371.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,371.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,300.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,281.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,333.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,333.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,365.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,273.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,334.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,379.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,392.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,400.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,268.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,371.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,371.48,
TROCAR  12MM SMOOTH,2001077,CDM,270,RC,,,outpatient,,,431.5,215.75,,418.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,258.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,388.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,388.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,258.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,294.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,258.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,348.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,348.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,382.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,286.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,349.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,396.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,409.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,418.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,280.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,258.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,258.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,258.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,388.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,258.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,258.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,388.35,
HANSSON 12MM BLUNT TIP,2001079,CDM,272,RC,,,outpatient,,,149.75,74.88,,145.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,134.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,89.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.78,
HULKA CLIPS,2001081,CDM,272,RC,,,outpatient,,,200.75,100.38,,194.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,180.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,180.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,137.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,177.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,133.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,162.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,184.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,190.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,194.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,130.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,180.68,
FULL BODY GARMENT,2001082,CDM,272,RC,,,outpatient,,,27,13.5,,26.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,24.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.2,90,
SUTURE PROLENE 2.0,2001083,CDM,272,RC,,,outpatient,,,66.25,33.13,,64.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,59.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,45.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,39.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,53.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,53.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,60.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,62.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,64.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,39.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,39.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.75,90,
UPPER BODY GARMENT,2001084,CDM,272,RC,,,outpatient,,,36.75,18.38,,35.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,33.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,33.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,90,
SURGI TYE,2001085,CDM,270,RC,,,outpatient,,,110,55,,106.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33,30,,,percent of total billed charges,Pays at 30% of total billed charges,99,90,,,percent of total billed charges,Pays at 90% of total billed charges,99,90,,,percent of total billed charges,Pays at 90% of total billed charges,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,75.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,72.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,89.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,101.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,104.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,106.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99,90,,,percent of total billed charges,Pays at 90% of total billed charges,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,99,
FIBERGLASS CAST TAPE 5,2001086,CDM,271,RC,,,outpatient,,,37.5,18.75,,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,34.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,
BIOPSY SITE IDENTIFIER,2001087,CDM,278,RC,,,outpatient,,,195.25,97.63,,189.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,175.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,175.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,133.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,117.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,157.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,173.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,129.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,158.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,179.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,185.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,189.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,126.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,117.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,175.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,117.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,175.73,
BIOPSY SITEMARKER,2001089,CDM,278,RC,,,outpatient,,,278.5,139.25,,270.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,250.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,190.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,224.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,246.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,184.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,225.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,256.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,264.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,270.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,181.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,250.65,
SPLINT W/THUMB  SM RIGHT,2001091,CDM,270,RC,,,outpatient,,,75.5,37.75,,73.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,69.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,73.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,90,
KIWI VAC DELIVERY SYSTEM,2001092,CDM,272,RC,,,outpatient,,,200.75,100.38,,194.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,180.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,180.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,137.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,177.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,133.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,162.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,184.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,190.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,194.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,130.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,180.68,
RHINO-ROCKET SEL PACK POST-OP,2001093,CDM,272,RC,,,outpatient,,,49,24.5,,47.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,44.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,33.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,29.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,32.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,39.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,45.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,46.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,47.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,29.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,29.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.4,90,
SPLINT W/THUMB  SM LEFT,2001095,CDM,270,RC,,,outpatient,,,75.5,37.75,,73.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,69.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,73.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,90,
MINISTEP -8MM RIBBED,2001096,CDM,272,RC,,,outpatient,,,401,200.5,,388.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,240.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,360.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,360.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,240.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,291.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,273.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,240.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,323.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,323.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,355.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,265.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,324.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,368.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,380.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,388.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,260.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,240.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,240.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,240.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,360.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,240.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,240.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,360.9,
ENDO MINI RETRACTOR 5MM,2001097,CDM,272,RC,,,outpatient,,,492.5,246.25,,477.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,295.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,443.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,443.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,295.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,358.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,336.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,295.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,397.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,397.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,436.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,326.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,398.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,453.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,467.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,477.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,320.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,295.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,295.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,295.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,443.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,295.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,295.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,443.25,
BAN NEBULIZER ADULT,2001099,CDM,271,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,90,
DRESSING ALLYVEN 3X3,2001100,CDM,272,RC,,,outpatient,,,13.5,6.75,,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,
SUTURE O SURGIDAC,2001101,CDM,270,RC,,,outpatient,,,94,47,,91.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,84.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,64.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,62.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,76.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,86.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,89.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,91.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.4,90,
TROCAR SHORT 5MM,2001103,CDM,270,RC,,,outpatient,,,185.5,92.75,,179.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,166.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,126.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,111.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,149.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,164.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,122.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,150.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,170.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,176.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,179.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,120.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,111.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,111.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,166.95,
BRAVO CAPSULE W/DELIVERY SYSTEM,2001105,CDM,272,RC,,,outpatient,,,704.75,352.38,,683.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,422.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,211.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,634.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,634.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,422.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,512.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,480.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,422.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,568.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,568.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,624.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,467.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,570.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,648.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,669.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,683.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,458.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,422.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,422.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,422.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,634.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,422.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,422.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,634.28,
COAXIAL ACHIEVER,2001107,CDM,272,RC,,,outpatient,,,229.75,114.88,,222.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,206.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,206.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,156.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,185.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,203.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,152.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,186.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,211.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,218.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,222.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,149.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,206.78,
COAXIAL ACHIEVER,2001109,CDM,272,RC,,,outpatient,,,98.5,49.25,,95.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,88.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,59.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,79.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,90.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,93.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,95.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,59.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,59.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.1,90,
TAPE MEDFIX 4'',2001110,CDM,272,RC,,,outpatient,,,37.5,18.75,,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,34.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,
CURRETTE 4MM RIDGE,2001111,CDM,272,RC,,,outpatient,,,89.75,44.88,,87.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,80.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,53.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,72.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,82.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,85.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,87.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,53.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,53.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.85,90,
VANSTIEN,2001112,CDM,272,RC,,,outpatient,,,148.25,74.13,,143.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,133.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,131.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,136.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,140.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,143.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,133.43,
VAC EXTRACTOR,2001113,CDM,272,RC,,,outpatient,,,161.5,80.75,,156.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,145.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,145.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,96.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,130.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,148.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,153.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,156.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,96.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,96.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,145.35,
STAPLE,2001114,CDM,272,RC,,,outpatient,,,249,124.5,,241.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,149.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,224.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,169.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,149.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,220.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,165.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,201.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,229.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,236.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,241.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,161.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,149.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,149.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,224.1,
TRIPORT,2001115,CDM,272,RC,,,outpatient,,,1060.25,530.13,,1028.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,636.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,318.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,954.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,954.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,636.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,771.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,723.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,636.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,855.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,855.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,939.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,702.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,858.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,975.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,1007.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,1028.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,689.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,636.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,636.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,636.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,954.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,636.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,636.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,954.23,
QUADPORT,2001117,CDM,272,RC,,,outpatient,,,1426.25,713.13,,1383.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,855.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,427.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,1283.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,1283.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,855.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1037.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,973.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,855.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1151.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1151.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1263.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,945.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1155.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1312.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,1354.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,1383.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,927.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,855.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,855.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,855.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1283.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,855.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,855.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1283.63,
ALLEVYN DRESSING SACRUM,2001118,CDM,272,RC,,,outpatient,,,67.5,33.75,,65.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,60.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,40.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,59.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,44.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,54.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,62.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,65.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,40.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.5,90,
MEASURING BALLOON,2001119,CDM,272,RC,,,outpatient,,,388.5,194.25,,376.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,233.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,349.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,349.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,233.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,282.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,265.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,233.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,313.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,344.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,257.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,314.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,357.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,369.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,376.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,252.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,233.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,233.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,233.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,349.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,233.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,233.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,349.65,
LIGASURE 5MM-37CM,2001121,CDM,272,RC,,,outpatient,,,1045.5,522.75,,1014.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,627.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,940.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,940.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,627.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,760.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,713.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,627.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,843.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,843.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,926.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,693.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,846.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,961.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,993.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,1014.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,679.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,627.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,627.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,627.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,940.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,627.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,627.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,940.95,
LIGASURE OPEN,2001122,CDM,272,RC,,,outpatient,,,3132.5,1566.25,,3038.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,1879.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,939.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,2819.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,2819.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1879.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2279.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2137.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1879.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2528.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2528.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2775.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2076.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2537.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2881.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,2975.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,3038.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,2036.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,1879.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1879.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1879.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2819.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1879.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1879.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2819.25,
CURRETTE 7MM RIDGE,2001125,CDM,272,RC,,,outpatient,,,89.75,44.88,,87.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,80.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,53.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,72.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,82.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,85.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,87.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,53.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,53.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.85,90,
LIGASURE 5MM-44MM,2001126,CDM,272,RC,,,outpatient,,,1224.25,612.13,,1187.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,734.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,367.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,1101.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,1101.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,734.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,890.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,835.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,734.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,988.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,988.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1084.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,811.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,991.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1126.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,1163.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,1187.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,795.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,734.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,734.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,734.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1101.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,734.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,734.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1101.83,
NEXPLANON,2001127,CDM,636,RC,,,outpatient,,,951,475.5,,922.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,570.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,934.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,855.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,855.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,570.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,691.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,649.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,570.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,767.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,767.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,842.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,630.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,770.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,874.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,903.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,922.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,618.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,570.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,570.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,570.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,855.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,570.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,570.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,855.9,
RELOAD MED THICK RADIAL,2001129,CDM,272,RC,,,outpatient,,,948.5,474.25,,920.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,569.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,284.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,853.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,853.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,569.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,690.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,647.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,569.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,765.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,765.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,840.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,628.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,768.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,872.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,901.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,920.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,616.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,569.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,569.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,569.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,853.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,569.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,569.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,853.65,
COAXIAL ACHIEVE BIOPSY SYSTEM,2001131,CDM,272,RC,,,outpatient,,,115.25,57.63,,111.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.73,
COAXIAL ACHIEVE 18X11,2001133,CDM,272,RC,,,outpatient,,,187.5,93.75,,181.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,168.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,127.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,151.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,166.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,124.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,151.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,172.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,178.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,181.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,168.75,
AMBU /CHILD DISP,2001134,CDM,271,RC,,,outpatient,,,63.75,31.88,,61.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,57.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,51.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,58.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,60.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,61.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.25,90,
COAXIAL ACHIEVE 18X20,2001135,CDM,272,RC,,,outpatient,,,228.25,114.13,,221.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,136.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,205.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,205.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,155.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,136.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,184.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,202.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,151.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,184.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,209.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,216.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,221.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,148.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,136.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,136.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,205.43,
AMBU /INFANT DISP,2001136,CDM,271,RC,,,outpatient,,,45.25,22.63,,43.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,40.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,41.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,42.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,43.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.15,90,
COAXIAL ACHIEVE 14GX11CM,2001137,CDM,272,RC,,,outpatient,,,229.75,114.88,,222.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,206.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,206.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,156.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,185.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,203.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,152.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,186.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,211.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,218.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,222.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,149.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,206.78,
CLOSED SUCTION SYSTEM W/SWIVEL,2001138,CDM,272,RC,,,outpatient,,,74.75,37.38,,72.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,49.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,60.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,68.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,72.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,90,
COAXIAL  BIOPSY  14G 20CM,2001139,CDM,272,RC,,,outpatient,,,179.75,89.88,,174.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,161.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,161.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,122.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,145.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,159.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,119.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,145.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,165.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,170.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,174.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,116.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,161.78,
BIOPSY  NEEDLE 8G 10CM,2001140,CDM,272,RC,,,outpatient,,,196,98,,190.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,176.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,176.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.61,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,133.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,117.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,158.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,173.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,129.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,158.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,180.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,186.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,190.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,127.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,117.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,117.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,176.4,
FEMORAL ARTERIAL LINE,2001141,CDM,272,RC,,,outpatient,,,120.25,60.13,,116.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.23,
AMBU /ADULT PEEP VALVE,2001142,CDM,271,RC,,,outpatient,,,33,16.5,,32.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,29.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.8,90,
COAXIAL ACHIEVE 20GX11CM,2001143,CDM,272,RC,,,outpatient,,,168,84,,162.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,151.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,151.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,111.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,136.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,154.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,159.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,151.2,
BIOPSY PUNCH 4MM,2001145,CDM,272,RC,,,outpatient,,,9.25,4.63,,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,90,
BIOPSY PUNCH 2MM,2001146,CDM,272,RC,,,outpatient,,,10,5,,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,30,,,percent of total billed charges,Pays at 30% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,90,
GUIDEWIRE  HYDROGLIDE 6F,2001147,CDM,278,RC,,,outpatient,,,268.75,134.38,,260.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,161.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,241.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,241.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,161.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195.54,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,183.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,161.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,216.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,216.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,238.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,178.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,217.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,247.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,255.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,260.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,174.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,161.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,241.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,161.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,161.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,241.88,
SAL SPETAL BUTTON,2001149,CDM,272,RC,,,outpatient,,,327.25,163.63,,317.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,196.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,294.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,294.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,223.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,196.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,264.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,264.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,289.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,216.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,265.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,301.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,310.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,317.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,212.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,196.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,294.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,196.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,294.53,
CATHETER MAMMO INJECTION,2001151,CDM,272,RC,,,outpatient,,,153.75,76.88,,149.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,138.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,138.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,104.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,124.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,101.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,124.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,141.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,146.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,149.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,138.38,
TRACHEOSTOMY TUBES 2.5,2001155,CDM,272,RC,,,outpatient,,,186,93,,180.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,167.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,167.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,126.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,164.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,123.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,150.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,171.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,176.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,180.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,120.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,167.4,
TRACH TUBE CUFFED DIS 6,2001156,CDM,272,RC,,,outpatient,,,128.5,64.25,,124.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,87.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,85.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,104.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,118.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,122.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,124.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,115.65,
TRACHEOSTOMY TUBES 3.0,2001157,CDM,272,RC,,,outpatient,,,186,93,,180.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,167.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,167.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,126.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,164.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,123.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,150.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,171.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,176.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,180.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,120.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,167.4,
TRACH TUBE #8 CUFFED,2001158,CDM,272,RC,,,outpatient,,,130.25,65.13,,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,88.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,105.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,119.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,123.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117.23,
TRACHEOSTOMY TUBES 3.5,2001159,CDM,272,RC,,,outpatient,,,186,93,,180.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,167.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,167.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,126.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,164.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,123.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,150.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,171.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,176.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,180.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,120.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,167.4,
TRACHEOSTOMY TUBES4.0,2001161,CDM,271,RC,,,outpatient,,,186,93,,180.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,167.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,167.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,126.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,164.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,123.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,150.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,171.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,176.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,180.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,120.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,167.4,
DISP INNER CANNULA #6,2001162,CDM,272,RC,,,outpatient,,,17.75,8.88,,17.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,15.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.65,90,
TRACHEOSTOMY TUBES 4.5,2001163,CDM,272,RC,,,outpatient,,,186,93,,180.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,167.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,167.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,126.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,164.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,123.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,150.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,171.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,176.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,180.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,120.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,167.4,
EZ FLOW NEBULIZER,2001164,CDM,272,RC,,,outpatient,,,96.75,48.38,,93.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,87.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,66.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,58.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,64.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,78.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,89.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,91.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,93.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,58.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,58.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.05,90,
FL ENEMA RING,2001165,CDM,270,RC,,,outpatient,,,12,6,,11.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,
DISP BIOPSY FORCEP COLON,2001166,CDM,272,RC,,,outpatient,,,206.75,103.38,,200.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,186.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,186.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,124.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,141.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,124.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,166.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,183.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,137.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,167.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,190.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,196.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,200.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,134.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,124.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,124.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,124.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,186.08,
TRACHEOSTOMY TUBES 5.0,2001167,CDM,272,RC,,,outpatient,,,186,93,,180.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,167.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,167.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,126.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,164.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,123.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,150.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,171.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,176.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,180.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,120.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,167.4,
DISP BIOPSY FORCEP GASTR,2001168,CDM,272,RC,,,outpatient,,,195.75,97.88,,189.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,176.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,176.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,133.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,158.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,173.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,129.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,158.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,180.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,185.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,189.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,127.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,176.18,
LOOP ELECTRODE 15X8,2001169,CDM,272,RC,,,outpatient,,,87.5,43.75,,84.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,78.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,70.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,84.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,52.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.5,90,
DISP HOT BI FORCEP COLON,2001170,CDM,272,RC,,,outpatient,,,232.25,116.13,,225.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,209.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,158.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,187.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,205.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,153.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,188.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,213.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,220.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,225.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,150.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,209.03,
TALON GRASPING DEVICE,2001171,CDM,272,RC,,,outpatient,,,365.75,182.88,,354.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,219.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,329.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,329.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,219.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,266.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,249.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,219.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,295.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,295.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,324.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,242.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,296.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,336.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,347.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,354.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,237.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,219.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,219.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,219.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,329.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,219.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,219.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,329.18,
DISP ROTATOR POLYPECTOMY,2001172,CDM,272,RC,,,outpatient,,,188.5,94.25,,182.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,169.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,169.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,128.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,167.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,124.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,152.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,173.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,179.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,182.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,122.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,169.65,
LOOP ELECTRODE 15X10,2001173,CDM,272,RC,,,outpatient,,,87.5,43.75,,84.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,78.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,70.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,84.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,52.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.5,90,
BODY ROTH NET,2001174,CDM,272,RC,,,outpatient,,,232.25,116.13,,225.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,209.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,158.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,187.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,205.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,153.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,188.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,213.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,220.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,225.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,150.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,209.03,
ELECRODE ECG 3M RED,2001175,CDM,270,RC,,,outpatient,,,1.75,0.88,,1.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,1.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.27,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,1.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,1.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,90,
DRESSING  SOLOSITE,2001177,CDM,272,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,90,
STARTER KIT FOR BRAVO,2001179,CDM,272,RC,,,outpatient,,,456,228,,442.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,273.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,410.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,410.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,273.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,331.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,311.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,273.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,368.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,368.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,404.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,302.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,369.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,419.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,433.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,442.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,296.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,273.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,410.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,273.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,273.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,410.4,
CENTRAL LINE DRESSNG KIT,2001180,CDM,272,RC,,,outpatient,,,18.5,9.25,,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,90,
LAP BAND HUBER ACCESS NEEDLE,2001181,CDM,278,RC,,,outpatient,,,16.5,8.25,,16.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,90,
GAUZE 4X4 NON STERILE,2001182,CDM,272,RC,,,outpatient,,,18,9,,17.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,90,
VACCUM PUMP 10 PK,2001183,CDM,272,RC,,,outpatient,,,47.25,23.63,,45.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,42.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,38.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,43.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,28.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,
IRRIGATION TRAY,2001184,CDM,272,RC,,,outpatient,,,9.5,4.75,,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,90,
MEDI HONEY TUBE,2001185,CDM,272,RC,,,outpatient,,,59,29.5,,57.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,53.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,40.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,47.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,39.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,54.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,56.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,57.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,35.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.4,90,
IV SET  W/ DUO VENT -AC,2001187,CDM,272,RC,,,outpatient,,,13,6.5,,12.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,90,
LARNGOSCOPE CHANNLED BLADE,2001189,CDM,272,RC,,,outpatient,,,157.25,78.63,,152.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.53,
LARNGOSCOPE STANDARD BLADE,2001191,CDM,272,RC,,,outpatient,,,157.25,78.63,,152.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.53,
DRESSING ALLEVYN SACRUM,2001192,CDM,272,RC,,,outpatient,,,35.25,17.63,,34.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,31.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.15,90,
KEMPREX 100CM X 50CM,2001194,CDM,272,RC,,,outpatient,,,252.75,126.38,,245.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,227.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,227.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,151.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,172.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,151.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,204.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,204.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,223.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,167.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,204.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,232.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,240.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,245.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,151.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,151.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,151.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,227.48,
DRESSINGSORBAVIEW,2001195,CDM,272,RC,,,outpatient,,,48.5,24.25,,47.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,43.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,33.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,29.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,32.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,39.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,44.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,46.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,47.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,29.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,29.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.1,90,
LMA CRYSTAL AIRWAY MASK,2001196,CDM,271,RC,,,outpatient,,,21,10.5,,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,90,
CANNULA INSTRUMENT3.0/26.5,2001197,CDM,272,RC,,,outpatient,,,40.25,20.13,,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,90,
DUODERM DRESSING 4X4,2001198,CDM,272,RC,,,outpatient,,,8.75,4.38,,8.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,90,
DUODERM SIGL 8X9 SACRAL,2001199,CDM,272,RC,,,outpatient,,,50.5,25.25,,48.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,45.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,40.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,46.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,47.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,48.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,30.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,30.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.3,90,
DRESSING MIPILEX6X6,2001200,CDM,272,RC,,,outpatient,,,36,18,,34.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,32.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,33.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.6,90,
BIOPSY PUNCH 3MM,2001201,CDM,278,RC,,,outpatient,,,9.25,4.63,,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,90,
DRESSING MIPILEX 3X3,2001202,CDM,272,RC,,,outpatient,,,11.75,5.88,,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,90,
DUOCLERM SIGL HEEL,2001203,CDM,272,RC,,,outpatient,,,60.75,30.38,,58.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,54.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,41.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,36.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,53.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,40.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,49.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,55.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,57.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,58.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,36.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,36.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.45,90,
ANT OST BIO SNY SUPPORT,2001204,CDM,272,RC,,,outpatient,,,3711,1855.5,,3599.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,2226.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1113.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,3339.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,3339.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,2226.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2700.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2532.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2226.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2995.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2995.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3288.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2460.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3005.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3414.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,3525.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,3599.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,2412.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,2226.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2226.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2226.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3339.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,2226.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2226.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3339.9,
DRESSING MATRIX 19.1 IN SQ HEX PROMOGAM,2001205,CDM,272,RC,,,outpatient,,,96.75,48.38,,93.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,87.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,66.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,58.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,64.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,78.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,89.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,91.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,93.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,58.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,58.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.05,90,
AVAULTA POST BIO SYN SUP,2001206,CDM,272,RC,,,outpatient,,,3711,1855.5,,3599.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,2226.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1113.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,3339.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,3339.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,2226.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2700.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2532.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2226.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2995.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2995.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3288.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2460.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3005.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3414.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,3525.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,3599.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,2412.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,2226.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2226.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2226.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3339.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,2226.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2226.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3339.9,
DRESSING PRISMA4.34X4.34,2001207,CDM,272,RC,,,outpatient,,,46.5,23.25,,45.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,41.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,37.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,42.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.9,90,
SCISSOR TIP DISP,2001209,CDM,272,RC,,,outpatient,,,201.5,100.75,,195.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,120.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,181.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,181.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.61,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,137.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,120.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,178.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,133.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,163.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,185.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,191.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,195.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,130.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,120.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,120.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,181.35,
BARRIER CREAM CLOTH,2001210,CDM,272,RC,,,outpatient,,,14.5,7.25,,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,90,
ORAL CLEANSING SUCTION SYSTEM,2001211,CDM,272,RC,,,outpatient,,,174.5,87.25,,169.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,157.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,119.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,104.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,140.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,115.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,141.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,160.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,165.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,169.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,104.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,157.05,
CHLORHEXIDINE CLOTHS,2001212,CDM,271,RC,,,outpatient,,,31.75,15.88,,30.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,29.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,30.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.05,90,
LI LOOP,2001214,CDM,272,RC,,,outpatient,,,912,456,,884.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,547.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,820.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,820.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,547.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,663.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,622.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,547.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,736.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,736.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,808.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,604.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,738.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,839.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,866.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,884.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,592.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,547.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,547.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,547.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,820.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,547.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,547.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,820.8,
BEMA TECULUM,2001215,CDM,272,RC,,,outpatient,,,1172.25,586.13,,1137.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,703.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,351.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,1055.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,1055.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,703.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,852.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,800.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,703.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,946.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,946.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1038.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,777.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,949.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1078.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,1113.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,1137.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,761.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,703.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,703.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,703.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1055.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,703.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,703.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1055.03,
VAPOTHERM HIGH FLOW CIRCUIT,2001216,CDM,270,RC,,,outpatient,,,222.75,111.38,,216.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,133.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,200.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,152.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,133.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,179.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,179.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,197.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,147.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,180.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,204.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,211.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,216.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,144.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,133.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,133.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,200.48,
PROMGRAN DRESSING,2001217,CDM,272,RC,,,outpatient,,,42.25,21.13,,40.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,38.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.35,90,
DRESSING  ROPE WOUND MAXORB,2001218,CDM,272,RC,,,outpatient,,,18.5,9.25,,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,90,
DRESSING  MEPITELL 4X7,2001219,CDM,272,RC,,,outpatient,,,54.5,27.25,,52.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,49.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,44.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,50.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,51.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,52.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.7,90,
DRESSING  ALLDRESS 6X6,2001220,CDM,272,RC,,,outpatient,,,25.25,12.63,,24.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.15,90,
DRESSING  MEPITELL 4X8,2001221,CDM,272,RC,,,outpatient,,,54.5,27.25,,52.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,49.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,44.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,50.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,51.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,52.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.7,90,
DRESSING IODASORB,2001222,CDM,272,RC,,,outpatient,,,54.5,27.25,,52.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,49.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,44.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,50.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,51.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,52.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.7,90,
FOAM SUPPORT,2001223,CDM,270,RC,,,outpatient,,,68,34,,65.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,61.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,45.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,55.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,62.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,65.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.8,90,
DRESSING ALLEVYN 6X6,2001224,CDM,272,RC,,,outpatient,,,29.25,14.63,,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,90,
DRESSING ALLEVYN 8.5X9,2001225,CDM,272,RC,,,outpatient,,,62.5,31.25,,60.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,56.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,42.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,50.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,57.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,59.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,60.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.5,90,
MEDI HONEY 4X5,2001226,CDM,272,RC,,,outpatient,,,47,23.5,,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,38.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,43.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,90,
PROXIMATE RELOAD STAPLER,2001227,CDM,272,RC,,,outpatient,,,718.25,359.13,,696.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,430.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,646.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,646.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,430.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,522.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,490.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,430.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,579.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,579.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,636.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,476.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,581.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,660.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,682.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,696.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,466.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,430.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,430.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,430.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,646.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,430.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,430.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,646.43,
RELOADS FOR PROXIMATE,2001228,CDM,272,RC,,,outpatient,,,359.25,179.63,,348.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,215.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,323.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,323.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,215.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,261.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,245.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,215.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,289.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,289.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,318.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,238.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,290.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,330.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,341.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,348.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,233.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,215.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,323.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,215.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,215.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,323.33,
NEXTRA HAMMERTOE IMPLANT 2ND TOE,2001229,CDM,278,RC,,,outpatient,,,3124.75,1562.38,,3031.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,1874.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,937.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,2812.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,2812.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1874.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2273.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2132.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1874.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2522.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2522.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2768.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2071.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2531.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2874.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,2968.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,3031.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,2031.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,1874.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1874.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1874.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2812.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1874.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1874.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2812.28,
SAL SPETAL BUTTON 7CM,2001230,CDM,272,RC,,,outpatient,,,248,124,,240.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,148.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,223.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,223.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,148.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,169.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,148.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,219.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,164.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,200.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,228.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,235.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,240.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,161.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,148.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,148.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,148.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,223.2,
MASK LARNGEAL SZ4,2001231,CDM,272,RC,,,outpatient,,,18,9,,17.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,90,
LMA sz1.5 mask,2001232,CDM,272,RC,,,outpatient,,,24,12,,23.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.4,90,
DRESSING MESALT 0.75X39,2001233,CDM,272,RC,,,outpatient,,,12.5,6.25,,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,90,
CATHETER CRICOTHOTOMY SET,2001234,CDM,272,RC,,,outpatient,,,425,212.5,,412.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,255,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,382.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,382.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,255,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,309.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,290.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,255,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,343.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,343.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,376.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,281.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,344.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,391,92,,,percent of total billed charges,Pays at 92% of total billed charges,403.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,412.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,276.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,255,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,255,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,255,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,382.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,255,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,255,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,382.5,
CASTING SYSTEM 4  REG BOOT,2001235,CDM,272,RC,,,outpatient,,,369.75,184.88,,358.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,221.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,332.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,332.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,221.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,252.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,221.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,298.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,298.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,327.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,245.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,299.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,340.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,351.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,358.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,240.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,221.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,332.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,221.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,221.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,332.78,
CASTING SYSTEM TCC 3  REG BOOT,2001236,CDM,271,RC,,,outpatient,,,307.75,153.88,,298.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,184.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,276.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,276.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,184.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,210.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,184.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,248.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,272.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,204.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,249.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,283.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,292.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,298.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,200.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,184.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,276.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,184.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,184.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,276.98,
CASTING SYSTEM BOOT LRG TCC,2001237,CDM,271,RC,,,outpatient,,,227.5,113.75,,220.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,136.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,204.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,204.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,155.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,136.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,183.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,201.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,150.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,184.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,209.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,216.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,220.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,147.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,136.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,204.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,136.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,204.75,
DRESSING  MOLNLYCKE 3X4,2001238,CDM,272,RC,,,outpatient,,,28.75,14.38,,27.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,90,
CASTING SYSTEM 3'',2001239,CDM,272,RC,,,outpatient,,,320,160,,310.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,192,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96,30,,,percent of total billed charges,Pays at 30% of total billed charges,288,90,,,percent of total billed charges,Pays at 90% of total billed charges,288,90,,,percent of total billed charges,Pays at 90% of total billed charges,192,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,218.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,192,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,258.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,258.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,283.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,212.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,259.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,294.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,304,95,,,percent of total billed charges,Pays at 95% of total billed charges,310.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,208,65,,,percent of total billed charges,Pays at 65% of total billed charges,192,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,288,90,,,percent of total billed charges,Pays at 90% of total billed charges,192,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,192,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,288,
CASTING SYSTEM 4'',2001240,CDM,272,RC,,,outpatient,,,320.25,160.13,,310.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,192.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,288.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,288.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,192.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,233.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,218.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,192.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,258.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,258.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,283.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,212.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,259.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,294.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,304.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,310.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,208.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,192.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,288.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,192.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,192.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,288.23,
CASTING SYSTEM 3''&4'',2001241,CDM,272,RC,,,outpatient,,,276.25,138.13,,267.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,165.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,248.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,248.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,188.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,165.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,222.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,244.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,183.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,223.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,254.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,262.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,267.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,179.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,165.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,248.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,165.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,248.63,
EXTRA LARGE BOOT TCC,2001242,CDM,272,RC,,,outpatient,,,227.25,113.63,,220.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,204.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,204.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,155.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,183.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,201.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,150.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,184.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,209.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,215.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,220.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,147.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,204.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,204.53,
DRESSING FOAM 2X2 HYDROFERA,2001243,CDM,272,RC,,,outpatient,,,30.5,15.25,,29.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,27.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.3,90,
DRESSING FOAM 4X4 HYDROFERA,2001244,CDM,272,RC,,,outpatient,,,29.5,14.75,,28.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,26.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,27.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.7,90,
DRESSING CALCIUM AGITE,2001245,CDM,272,RC,,,outpatient,,,14,7,,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,90,
LMA sz2.0 mask,2001246,CDM,272,RC,,,outpatient,,,29.5,14.75,,28.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,26.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,27.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.7,90,
LMA sz2.5 mask,2001247,CDM,272,RC,,,outpatient,,,29.5,14.75,,28.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,26.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,27.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.7,90,
ANCHOR FAST,2001248,CDM,270,RC,,,outpatient,,,39.5,19.75,,38.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,36.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,37.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,38.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.7,90,
DRESSING ENLUXTRA 4X4,2001249,CDM,272,RC,,,outpatient,,,63.25,31.63,,61.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,56.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,51.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,58.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,60.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,61.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,37.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.95,90,
DRESSING OPTI-LOCK 5X51/2,2001250,CDM,272,RC,,,outpatient,,,11.25,5.63,,10.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,90,
BASINS DISPOSABLE,2001251,CDM,270,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
DRESSING  WOUND HYDROGEL,2001252,CDM,272,RC,,,outpatient,,,12.75,6.38,,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,
DRESSING  DERMASYN,2001253,CDM,272,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
DRESSING  INTRASITE,2001254,CDM,272,RC,,,outpatient,,,22.75,11.38,,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,90,
DRESSING  PURILON,2001255,CDM,272,RC,,,outpatient,,,14.75,7.38,,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,90,
BOVIE EXTENDED BLADE,2001256,CDM,272,RC,,,outpatient,,,26.25,13.13,,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,90,
TOE IMPLANT  KIT FLEX HINGE,2001257,CDM,272,RC,,,outpatient,,,3411.75,1705.88,,3309.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,2047.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1023.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,3070.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,3070.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,2047.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2482.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2328.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2047.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2753.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2753.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3023.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2261.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2763.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3138.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,3241.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,3309.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,2217.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,2047.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2047.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2047.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3070.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,2047.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2047.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3070.58,
DRESSING  AQUACELL EXTRA 2X2,2001258,CDM,272,RC,,,outpatient,,,8.25,4.13,,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,90,
DRESSING  AQUACELL EXTRA 6X6,2001259,CDM,272,RC,,,outpatient,,,47,23.5,,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,38.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,43.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,90,
LARNGO TRACH MULOSAL,2001260,CDM,272,RC,,,outpatient,,,48.75,24.38,,47.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,43.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,33.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,32.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,39.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,44.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,46.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,47.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,90,
BIOPSY PUNCH 5MM,2001261,CDM,272,RC,,,outpatient,,,8,4,,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,90,
DRESSING  SELF ADHER LATEX FREE,2001262,CDM,272,RC,,,outpatient,,,6.75,3.38,,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,90,
SUTURE 5-0 BIOSYN P-12,2001263,CDM,272,RC,,,outpatient,,,55.5,27.75,,53.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,49.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,44.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,51.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,52.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,53.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,33.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.3,90,
SUTURE POLYSORB 0 GS-21,2001264,CDM,272,RC,,,outpatient,,,67.75,33.88,,65.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,44.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,54.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,62.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,65.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.65,90,
SUTURE MONOSOF2-0 C-15,2001265,CDM,272,RC,,,outpatient,,,6.25,3.13,,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,90,
SUTURE 3-0 VICRYL TIE,2001266,CDM,272,RC,,,outpatient,,,42.25,21.13,,40.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,38.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.35,90,
UNDER BODY BLANKET,2001267,CDM,272,RC,,,outpatient,,,72.5,36.25,,70.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,65.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,49.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,43.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,48.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,58.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,66.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,68.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,70.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,43.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,43.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.5,90,
SUTURE 0 TRICRON DOUBLE ARMED CV-305,2001268,CDM,272,RC,,,outpatient,,,26,13,,25.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,23.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.6,90,
WAFFLE CUSHION,2001269,CDM,270,RC,,,outpatient,,,77,38.5,,74.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,51.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,62.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,73.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.2,90,
SUTURE POLYSORB  2.0 V-20,2001270,CDM,272,RC,,,outpatient,,,6.5,3.25,,6.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,90,
SUTURE 2-0 VICRYL 18  TIE,2001271,CDM,272,RC,,,outpatient,,,29,14.5,,28.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.4,90,
SUTURE VICRYL COATED PLUS  0,2001272,CDM,272,RC,,,outpatient,,,36.75,18.38,,35.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,33.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,33.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,90,
SUTURE SILK 0 BLACK,2001273,CDM,272,RC,,,outpatient,,,13.75,6.88,,13.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.25,90,
SUTURE SURIPRO,2001274,CDM,272,RC,,,outpatient,,,34.5,17.25,,33.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,31.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,32.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.7,90,
SUTURE SILK 2-0 BLACK,2001275,CDM,272,RC,,,outpatient,,,35.5,17.75,,34.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,90,
SUTURE ETHIBOND,2001276,CDM,272,RC,,,outpatient,,,156.5,78.25,,151.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,140.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,93.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,106.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,93.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,138.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,103.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,126.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,143.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,148.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,151.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,93.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,93.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,93.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,140.85,
DISSECTOR SHAVER,2001277,CDM,272,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
RELOAD TA60,2001278,CDM,272,RC,,,outpatient,,,746.75,373.38,,724.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,448.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,672.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,672.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,448.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,543.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,509.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,448.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,602.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,602.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,661.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,495.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,604.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,687.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,709.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,724.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,485.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,448.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,448.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,448.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,672.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,448.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,448.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,672.08,
RELOADXR60B,2001279,CDM,272,RC,,,outpatient,,,373.5,186.75,,362.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,224.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,336.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,336.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,254.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,224.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,301.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,301.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,330.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,247.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,302.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,343.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,354.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,362.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,242.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,224.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,336.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,224.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,336.15,
HSG TRAY,2001280,CDM,272,RC,,,outpatient,,,122,61,,118.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,109.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,98.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,115.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,118.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,109.8,
HSG CATH,2001281,CDM,272,RC,,,outpatient,,,131.75,65.88,,127.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,118.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,79.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,106.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,121.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,125.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,127.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,79.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,79.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,118.58,
10b FOOT CRYP/CUFF COOLER,2001282,CDM,272,RC,,,outpatient,,,187.25,93.63,,181.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,168.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,127.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,151.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,165.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,124.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,151.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,172.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,177.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,181.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,168.53,
10C FOOT CRYO/CUFF COOLER,2001283,CDM,272,RC,,,outpatient,,,187.25,93.63,,181.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,168.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,127.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,151.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,165.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,124.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,151.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,172.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,177.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,181.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,168.53,
SUTURE 3-0 polysorb V-20 UNDYED,2001284,CDM,272,RC,,,outpatient,,,9.5,4.75,,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,90,
SUTURE SOFSILK 3.0 V-20,2001285,CDM,272,RC,,,outpatient,,,4.75,2.38,,4.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,4.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.85,90,
SUTURE POLYSORB 3.0 GU46,2001286,CDM,272,RC,,,outpatient,,,14,7,,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,90,
SUTURE SUGIPRO 0 BLUE GS-21,2001287,CDM,272,RC,,,outpatient,,,7.25,3.63,,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,90,
SUTURE 3-0 VICRYL REEL,2001288,CDM,272,RC,,,outpatient,,,12.5,6.25,,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,90,
SUTURE POLYSORB 2.0 GS-22,2001289,CDM,272,RC,,,outpatient,,,26.25,13.13,,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,90,
SUTURE 0 POLYSORB GS22 POPS,2001290,CDM,272,RC,,,outpatient,,,27.5,13.75,,26.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,90,
SUTURE GOR-E -TEX,2001291,CDM,272,RC,,,outpatient,,,113.25,56.63,,109.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,101.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,75.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,104.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,107.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,109.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,101.93,
TRAPEASE QUAD,2001292,CDM,272,RC,,,outpatient,,,21.75,10.88,,21.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,21.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,90,
SUTURE 2-0 27IN VICRYL PLUS,2001293,CDM,270,RC,,,outpatient,,,10,5,,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,30,,,percent of total billed charges,Pays at 30% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,90,
SUTURE POLYSORB 2.0 CL-811,2001294,CDM,270,RC,,,outpatient,,,11,5.5,,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,90,
LMA sz4.0 mask streight,2001296,CDM,272,RC,,,outpatient,,,34,17,,32.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,31.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,32.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.4,90,
LMA sz3.0 mask streight,2001297,CDM,272,RC,,,outpatient,,,33,16.5,,32.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,29.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.8,90,
SUTURE  PROLENE 6.0 VIOLET,2001298,CDM,272,RC,,,outpatient,,,59.25,29.63,,57.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,53.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,40.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,47.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,39.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,54.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,56.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,57.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.55,90,
ADAPTOR AREOSOL,2001299,CDM,270,RC,,,outpatient,,,83.75,41.88,,81.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,75.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,57.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,55.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,67.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,77.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,79.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,81.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.25,90,
ENDO CLIP BOWEL,2001300,CDM,272,RC,,,outpatient,,,630.75,315.38,,611.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,378.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,189.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,567.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,567.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,378.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,458.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,430.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,378.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,509.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,509.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,558.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,418.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,510.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,580.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,599.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,611.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,409.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,378.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,378.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,378.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,567.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,378.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,378.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,567.68,
ENDOcuff green,2001301,CDM,272,RC,,,outpatient,,,115,57.5,,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,105.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.5,
SWIVELOCK 4.75,2001302,CDM,272,RC,,,outpatient,,,953,476.5,,924.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,571.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,285.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,857.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,857.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,571.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,693.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,650.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,571.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,769.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,769.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,844.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,631.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,771.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,876.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,905.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,924.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,619.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,571.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,571.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,571.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,857.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,571.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,571.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,857.7,
SWIVELOCK 5.5,2001303,CDM,272,RC,,,outpatient,,,953,476.5,,924.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,571.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,285.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,857.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,857.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,571.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,693.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,650.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,571.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,769.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,769.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,844.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,631.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,771.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,876.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,905.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,924.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,619.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,571.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,571.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,571.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,857.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,571.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,571.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,857.7,
FIBERWIRE #2 W/ NEEDLE,2001304,CDM,272,RC,,,outpatient,,,106.75,53.38,,103.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,96.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,72.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,96.08,
CANNULA TWIST IN 7X7,2001305,CDM,272,RC,,,outpatient,,,119.5,59.75,,115.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,107.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,81.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,96.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,109.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,113.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,115.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,107.55,
APOLLO WANDS XL,2001306,CDM,272,RC,,,outpatient,,,453.25,226.63,,439.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,407.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,407.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,329.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,309.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,365.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,365.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,401.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,300.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,367.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,416.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,430.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,439.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,294.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,407.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,407.93,
BARRELL BURR 5.5,2001307,CDM,272,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
CANNULA PARTIAL THREAED 7X9,2001308,CDM,272,RC,,,outpatient,,,119.5,59.75,,115.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,107.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,81.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,96.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,109.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,113.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,115.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,107.55,
SHAVER EXCALIBUR 4.0,2001309,CDM,272,RC,,,outpatient,,,141.5,70.75,,137.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,127.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,130.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.35,
PIN CAP,2001310,CDM,270,RC,,,outpatient,,,115,57.5,,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,105.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.5,
PIN CAP,2001311,CDM,270,RC,,,outpatient,,,115,57.5,,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,105.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.5,
PIN CAP,2001312,CDM,270,RC,,,outpatient,,,115,57.5,,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,105.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.5,
PIN CAP,2001313,CDM,270,RC,,,outpatient,,,115,57.5,,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,105.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.5,
PIN CAP,2001314,CDM,270,RC,,,outpatient,,,115,57.5,,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,105.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.5,
PIN CAP,2001315,CDM,270,RC,,,outpatient,,,115,57.5,,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,105.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.5,
PIN CAP,2001316,CDM,270,RC,,,outpatient,,,115,57.5,,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,105.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.5,
PIN CAP,2001317,CDM,270,RC,,,outpatient,,,115,57.5,,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,105.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.5,
K WIRE DOUBLE HEADED,2001318,CDM,270,RC,,,outpatient,,,413.5,206.75,,401.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,248.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,372.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,372.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,248.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,300.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,282.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,248.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,333.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,333.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,366.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,274.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,334.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,380.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,392.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,401.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,268.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,248.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,248.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,248.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,372.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,248.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,248.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,372.15,
PIN CAP YELLOW,2001319,CDM,270,RC,,,outpatient,,,105.25,52.63,,102.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,71.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,69.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,85.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,96.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,99.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,102.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,94.73,
PIN CAP BLUE,2001320,CDM,270,RC,,,outpatient,,,105.25,52.63,,102.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,71.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,69.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,85.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,96.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,99.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,102.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,94.73,
PIN CAP WHITE,2001321,CDM,270,RC,,,outpatient,,,105.25,52.63,,102.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,71.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,69.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,85.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,96.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,99.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,102.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,94.73,
PIN CAP RED,2001322,CDM,270,RC,,,outpatient,,,105.25,52.63,,102.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,71.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,69.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,85.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,96.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,99.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,102.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,94.73,
TRACH TUBE #4 CUFFED,2001323,CDM,272,RC,,,outpatient,,,130.25,65.13,,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,88.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,105.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,119.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,123.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117.23,
TRACH TUBE #6 CUFFED,2001324,CDM,272,RC,,,outpatient,,,130.25,65.13,,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,88.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,105.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,119.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,123.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117.23,
TRACH SZ 3.0 SHLEY,2001325,CDM,272,RC,,,outpatient,,,224.75,112.38,,218.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,153.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,181.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,199.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,182.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,206.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,213.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,218.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,202.28,
TRACH SZ 3.5 SHLEY,2001326,CDM,272,RC,,,outpatient,,,224.75,112.38,,218.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,153.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,181.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,199.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,182.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,206.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,213.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,218.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,202.28,
TRACH SZ 4.0 SHLEY,2001327,CDM,272,RC,,,outpatient,,,224.75,112.38,,218.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,153.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,181.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,199.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,182.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,206.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,213.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,218.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,202.28,
TRACH SZ 4.5 SHLEY,2001328,CDM,272,RC,,,outpatient,,,224.75,112.38,,218.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,153.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,181.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,199.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,182.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,206.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,213.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,218.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,202.28,
TRACH SZ 5.0SHLEY,2001329,CDM,272,RC,,,outpatient,,,224.75,112.38,,218.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,153.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,181.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,199.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,182.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,206.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,213.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,218.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,202.28,
BEAVER BLADE STRAIGHT BLUE MINI 180,2001330,CDM,270,RC,,,outpatient,,,28,14,,27.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,90,
BEAVER BLADE 4MM ROUNDTIP SHARP,2001331,CDM,270,RC,,,outpatient,,,113.5,56.75,,110.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,102.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,102.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,75.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,104.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,107.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,110.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.15,
BEAVER BLADE SLIT  3,2001332,CDM,270,RC,,,outpatient,,,58.75,29.38,,56.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,52.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,40.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,47.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,54.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,55.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,56.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,35.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.25,90,
CANNULA INNER FENESTRATED,2001334,CDM,272,RC,,,outpatient,,,224.75,112.38,,218.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,153.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,181.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,199.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,182.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,206.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,213.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,218.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,202.28,
CANNULA INNER SZ6,2001335,CDM,271,RC,,,outpatient,,,23.25,11.63,,22.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,20.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.95,90,
INNER CANNULA SZ4,2001336,CDM,271,RC,,,outpatient,,,24,12,,23.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.4,90,
INNER CANNULA SZ8,2001337,CDM,271,RC,,,outpatient,,,24,12,,23.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.4,90,
GOWN FLYTE TOGA 2XL,2001338,CDM,270,RC,,,outpatient,,,172.25,86.13,,167.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,117.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,139.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,158.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,163.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,167.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,155.03,
DRESSING  AQUACELL   AG 3.5x10,2001339,CDM,272,RC,,,outpatient,,,149.25,74.63,,144.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,134.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.33,
TROCAR EVACUATOR 400CC,2001340,CDM,272,RC,,,outpatient,,,63,31.5,,61.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,56.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,51.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,57.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,59.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,61.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.8,90,
PLATE 2H SYNDESMOSIS,2001341,CDM,272,RC,,,outpatient,,,5599.5,2799.75,,5431.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,3359.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1679.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,5039.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5039.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,3359.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4074.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3821.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3359.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4519.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4519.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4961.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3712.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4535.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5151.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,5319.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,5431.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,3639.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,3359.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3359.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3359.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5039.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,3359.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3359.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,5039.55,
TRIMANO BEACH CHAIR KIT,2001342,CDM,272,RC,,,outpatient,,,179,89.5,,173.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,107.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,161.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,161.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,122.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,107.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,144.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,158.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,118.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,144.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,164.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,170.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,173.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,116.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,107.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,107.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,161.1,
FIBERLINK 1.3MM,2001343,CDM,272,RC,,,outpatient,,,202.75,101.38,,196.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,138.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,163.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,179.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,134.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,164.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,186.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,192.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,196.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,182.48,
DOUBLE SYRINGE,2001344,CDM,272,RC,,,outpatient,,,357.5,178.75,,346.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,214.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,321.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,321.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,214.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,260.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,243.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,214.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,288.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,288.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,316.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,237.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,289.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,328.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,339.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,346.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,232.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,214.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,321.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,214.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,214.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,321.75,
BIOCOMP SWIVELOCK 6.25X15,2001345,CDM,272,RC,,,outpatient,,,965.25,482.63,,936.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,579.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,289.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,868.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,868.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,579.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,702.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,658.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,579.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,779.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,779.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,855.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,639.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,781.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,888.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,916.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,936.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,627.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,579.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,579.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,579.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,868.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,579.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,579.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,868.73,
SCREW TENO,2001346,CDM,272,RC,,,outpatient,,,464.75,232.38,,450.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,278.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,418.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,418.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,278.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,338.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,317.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,278.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,375.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,375.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,411.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,308.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,376.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,427.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,441.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,450.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,302.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,278.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,278.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,278.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,418.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,278.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,278.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,418.28,
IMPLANT KIT,2001347,CDM,272,RC,,,outpatient,,,3514.75,1757.38,,3409.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,2108.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1054.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,3163.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,3163.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,2108.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2557.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2398.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2108.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2837.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2837.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3114.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2330.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2846.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3233.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,3339.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,3409.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,2284.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,2108.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2108.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2108.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3163.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,2108.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2108.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3163.28,
DRESSING  AQUACELL   AG 3.5x14,2001348,CDM,272,RC,,,outpatient,,,165.75,82.88,,160.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,149.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,109.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,134.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,152.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,157.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,160.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,107.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,149.18,
TROCAR EVACUATOR 400CC 10FR,2001349,CDM,272,RC,,,outpatient,,,65.75,32.88,,63.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,59.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,39.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,53.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,53.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,60.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,62.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,39.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,39.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.45,90,
TAPE RETRACTION DACRON,2001350,CDM,272,RC,,,outpatient,,,16.25,8.13,,15.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,90,
T-ROPE PLATE,2001351,CDM,272,RC,,,outpatient,,,2442.5,1221.25,,2369.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,1465.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,732.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,2198.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,2198.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1465.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1777.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1667.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1465.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1971.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1971.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2164.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1619.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1978.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2247.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,2320.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,2369.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,1587.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,1465.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1465.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1465.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2198.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1465.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1465.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2198.25,
SUTURE TAK,2001352,CDM,272,RC,,,outpatient,,,370.5,185.25,,359.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,222.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,333.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,333.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,252.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,222.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,299.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,328.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,245.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,300.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,340.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,351.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,359.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,240.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,222.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,333.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,222.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,333.45,
PERCUTANEOUS INSERTION KIT,2001353,CDM,272,RC,,,outpatient,,,509,254.5,,493.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,305.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,458.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,458.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,305.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,347.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,305.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,410.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,410.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,451.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,337.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,412.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,468.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,483.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,493.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,330.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,305.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,305.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,305.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,458.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,305.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,305.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,458.1,
TRUSHOT W/YKNOT,2001354,CDM,272,RC,,,outpatient,,,3347.5,1673.75,,3247.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,2008.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1004.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,3012.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,3012.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,2008.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2435.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2284.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2008.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2702.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2702.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2966.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2219.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2711.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3079.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,3180.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,3247.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,2175.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,2008.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2008.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2008.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3012.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,2008.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2008.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3012.75,
SUTURE ANCHOR BIOCOMPSITE 5.5,2001355,CDM,272,RC,,,outpatient,,,730.25,365.13,,708.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,438.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,219.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,657.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,657.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,438.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,531.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,498.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,438.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,589.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,647.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,484.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,591.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,671.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,693.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,708.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,474.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,438.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,438.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,438.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,657.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,438.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,438.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,657.23,
SPEED GRAFT 9.0X222,2001356,CDM,272,RC,,,outpatient,,,5222,2611,,5065.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,3133.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1566.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,4699.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,4699.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,3133.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3799.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3564.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3133.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4215.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4215.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4627.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3462.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4229.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4804.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,4960.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,5065.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,3394.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,3133.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3133.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3133.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4699.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,3133.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3133.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4699.8,
SUTURE POLYSORB 0 GS-22,2001367,CDM,272,RC,,,outpatient,,,47,23.5,,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,38.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,43.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,90,
RAPID RHINO-ROCKET ANTERIOR AIRWAY,2001368,CDM,272,RC,,,outpatient,,,191.5,95.75,,185.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,172.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,172.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,130.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,114.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,169.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,126.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,155.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,176.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,181.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,185.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,114.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,114.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,172.35,
FL BE TIPS EZ-M,2001369,CDM,270,RC,,,outpatient,,,17.25,8.63,,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,90,
SAW BLADE,2001370,CDM,272,RC,,,outpatient,,,188.5,94.25,,182.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,169.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,169.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,128.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,167.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,124.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,152.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,173.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,179.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,182.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,122.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,169.65,
SAW BLADE,2001371,CDM,272,RC,,,outpatient,,,188.5,94.25,,182.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,169.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,169.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,128.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,167.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,124.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,152.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,173.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,179.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,182.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,122.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,169.65,
MINERVA,2001372,CDM,272,RC,,,outpatient,,,2224.5,1112.25,,2157.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,1334.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,667.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,2002.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,2002.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1334.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1618.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1518.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1334.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1795.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1795.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1971.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1474.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1801.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2046.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,2113.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,2157.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,1445.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,1334.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1334.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1334.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2002.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1334.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1334.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2002.05,
FLIPCUTTER SHORT10 MM,2001373,CDM,272,RC,,,outpatient,,,774.5,387.25,,751.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,697.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,697.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,563.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,528.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,625.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,625.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,686.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,513.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,627.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,712.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,735.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,751.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,503.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,697.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,697.05,
FLIPCUTTER SHORT10.5 MM,2001374,CDM,272,RC,,,outpatient,,,774.5,387.25,,751.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,697.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,697.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,563.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,528.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,625.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,625.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,686.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,513.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,627.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,712.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,735.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,751.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,503.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,697.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,697.05,
CLIPS FOR CLIP APPLIER,2001375,CDM,272,RC,,,outpatient,,,40.25,20.13,,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,90,
SCREW BIOCOMPOSITE 8X30MM,2001376,CDM,278,RC,,,outpatient,,,703.25,351.63,,682.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,632.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,632.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,511.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,479.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,567.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,567.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,623.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,466.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,569.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,646.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,668.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,682.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,457.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,632.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,632.93,
SCREW BIOCOMPOSITE 9X30MM,2001377,CDM,278,RC,,,outpatient,,,703.25,351.63,,682.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,632.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,632.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,511.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,479.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,567.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,567.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,623.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,466.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,569.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,646.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,668.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,682.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,457.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,632.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,632.93,
SCREW BIOCOMPOSITE 10X30MM,2001378,CDM,278,RC,,,outpatient,,,703.25,351.63,,682.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,632.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,632.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,511.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,479.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,567.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,567.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,623.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,466.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,569.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,646.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,668.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,682.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,457.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,632.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,632.93,
TRANSTIBIAL ACL W/O SAWBLADE,2001379,CDM,272,RC,,,outpatient,,,345.75,172.88,,335.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,207.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,311.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,311.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,235.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,207.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,279.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,279.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,306.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,229.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,280.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,318.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,328.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,335.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,224.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,207.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,311.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,207.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,311.18,
IMPLANT ACL /PCL REPAIR,2001380,CDM,272,RC,,,outpatient,,,1429.75,714.88,,1386.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,857.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,428.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,1286.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,1286.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,857.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1040.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,975.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,857.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1154.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1154.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1266.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,947.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1158.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1315.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,1358.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,1386.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,929.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,857.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,857.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,857.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1286.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,857.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,857.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1286.78,
SCREW HUMERUS T2 ADVANCED COMP,2001381,CDM,278,RC,,,outpatient,,,611,305.5,,592.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,366.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,549.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,549.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,366.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,444.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,417.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,366.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,493.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,493.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,541.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,405.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,494.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,562.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,580.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,592.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,397.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,366.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,366.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,366.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,549.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,366.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,366.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,549.9,
IL HUMERUS 7MMX20MM T2,2001382,CDM,278,RC,,,outpatient,,,4772.75,2386.38,,4629.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,2863.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4295.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,4295.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2863.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3472.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3257.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2863.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3852.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3852.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4229.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3164.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3865.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4390.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,4534.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,4629.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,3102.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,2863.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2863.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2863.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4295.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2863.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2863.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4295.48,
SCREW SHAFT T2 4MMX30MM,2001383,CDM,278,RC,,,outpatient,,,651,325.5,,631.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,585.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,585.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,473.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,444.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,525.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,525.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,576.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,431.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,527.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,598.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,618.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,631.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,423.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,585.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,585.9,
SCREW SHAFT T2 4MMX36MM,2001384,CDM,278,RC,,,outpatient,,,651,325.5,,631.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,585.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,585.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,473.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,444.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,525.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,525.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,576.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,431.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,527.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,598.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,618.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,631.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,423.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,585.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,585.9,
SCREW SHAFT T2 4MMX40MM,2001385,CDM,278,RC,,,outpatient,,,651,325.5,,631.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,585.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,585.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,473.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,444.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,525.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,525.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,576.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,431.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,527.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,598.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,618.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,631.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,423.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,585.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,585.9,
SCREW LOCKING T2 F/T,2001386,CDM,278,RC,,,outpatient,,,652.5,326.25,,632.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,587.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,587.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,474.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,445.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,526.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,526.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,578.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,432.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,528.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,600.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,619.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,632.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,424.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,587.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,587.25,
SCREW LOCKING T2 F/T,2001387,CDM,278,RC,,,outpatient,,,647.5,323.75,,628.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,388.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,582.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,582.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,388.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,471.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,441.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,388.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,522.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,522.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,573.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,429.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,524.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,595.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,615.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,628.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,420.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,388.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,388.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,388.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,582.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,388.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,388.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,582.75,
TOE IMPLANT SS TOE FLEX HINGE  4S,2001388,CDM,272,RC,,,outpatient,,,3381,1690.5,,3279.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,2028.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1014.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,3042.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,3042.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,2028.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2460.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2307.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2028.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2729.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2729.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2995.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2241.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2738.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3110.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,3211.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,3279.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,2197.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,2028.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2028.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2028.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3042.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,2028.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2028.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3042.9,
DRILL BIT HAMER 3.0,2001389,CDM,272,RC,,,outpatient,,,236,118,,228.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,141.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,212.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,212.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,161.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,141.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,190.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,209.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,156.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,191.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,217.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,224.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,228.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,153.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,141.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,141.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,212.4,
SUTURE ANCHOR MICRO CORKSCREW,2001390,CDM,272,RC,,,outpatient,,,640.25,320.13,,621.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,576.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,576.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,465.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,436.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,516.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,516.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,567.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,424.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,518.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,589.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,608.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,621.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,416.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,576.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,576.23,
SCREW LO PRO SS 4.0mm x50 cann sht thd,2001391,CDM,278,RC,,,outpatient,,,1628.5,814.25,,1579.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,488.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,1465.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,1465.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1184.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1111.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1314.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1314.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1443.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1079.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1319.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1498.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,1547.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,1579.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,1058.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1465.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1465.65,
DRILL BIT 2.5MM,2001392,CDM,272,RC,,,outpatient,,,196.75,98.38,,190.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,177.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,177.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,134.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,118.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,158.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,130.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,159.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,181.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,186.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,190.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,127.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,118.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,118.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,177.08,
CLAV FRAC PLT CENTRAL THIRD LT SS,2001393,CDM,278,RC,,,outpatient,,,1909.25,954.63,,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,572.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1389.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1303.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1691.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1265.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1546.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1756.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,1813.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1241.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1718.33,
LO PRO SCREW CORTEX 3.5MMX18MM,2001394,CDM,278,RC,,,outpatient,,,258.5,129.25,,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,176.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,229.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,171.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,209.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,237.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,245.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,232.65,
PSN TIB STM 5 DEGREE SZ E L,2001395,CDM,278,RC,,,outpatient,,,1909.25,954.63,,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,572.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1389.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1303.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1691.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1265.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1546.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1756.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,1813.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1241.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1718.33,
PSN FEM CR CMT CCR STD SZ 8 L,2001396,CDM,278,RC,,,outpatient,,,4492,2246,,4357.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1347.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3268.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3065.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3625.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3625.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3980.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2978.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3638.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4132.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,4267.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,4357.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,2919.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4042.8,
PSN ASF,2001397,CDM,278,RC,,,outpatient,,,2470.75,1235.38,,2396.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,741.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1797.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1686.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1994.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1994.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2189.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1638.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2001.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2273.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,2347.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,2396.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,1605.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2223.68,
PLATE LOCKING DISTAL SS LFT 6H,2001398,CDM,272,RC,,,outpatient,,,1628.5,814.25,,1579.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,488.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,1465.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,1465.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1184.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1111.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1314.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1314.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1443.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1079.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1319.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1498.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,1547.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,1579.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,1058.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1465.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1465.65,
IMPLANT SYSTEM,2001399,CDM,278,RC,,,outpatient,,,2376.25,1188.13,,2304.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,1425.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,712.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,2138.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,2138.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,1425.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1728.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1621.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1425.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1918.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1918.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2105.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1575.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1924.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2186.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,2257.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,2304.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,1544.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,1425.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1425.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1425.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2138.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,1425.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1425.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2138.63,
FIBERSTICK,2001400,CDM,272,RC,,,outpatient,,,214.83,107.42,,208.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,128.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,193.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,193.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,146.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,128.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,173.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,190.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,142.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,174.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,197.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,204.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,208.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,128.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,128.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,193.35,
PORTAL SKID,2001401,CDM,272,RC,,,outpatient,,,200,100,,194,97,,,percent of total billed charges,Pays at 97% of total billed charges,120,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,30,,,percent of total billed charges,Pays at 30% of total billed charges,180,90,,,percent of total billed charges,Pays at 90% of total billed charges,180,90,,,percent of total billed charges,Pays at 90% of total billed charges,120,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,136.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,120,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,161.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,177.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,132.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,162,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,184,92,,,percent of total billed charges,Pays at 92% of total billed charges,190,95,,,percent of total billed charges,Pays at 95% of total billed charges,194,97,,,percent of total billed charges,Pays at 97% of total billed charges,130,65,,,percent of total billed charges,Pays at 65% of total billed charges,120,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180,90,,,percent of total billed charges,Pays at 90% of total billed charges,120,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,120,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,180,
SCREW BIOCOMPOSITE 08X20MM,2001402,CDM,278,RC,,,outpatient,,,703.25,351.63,,682.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,632.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,632.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,511.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,479.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,567.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,567.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,623.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,466.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,569.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,646.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,668.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,682.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,457.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,632.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,632.93,
SCREW BIOCOMPOSITE 09X20MM,2001403,CDM,278,RC,,,outpatient,,,703.25,351.63,,682.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,632.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,632.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,511.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,479.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,567.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,567.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,623.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,466.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,569.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,646.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,668.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,682.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,457.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,632.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,632.93,
OATS SET 6MM,2001404,CDM,272,RC,,,outpatient,,,1128.4,564.2,,1094.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,677.04,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,338.52,30,,,percent of total billed charges,Pays at 30% of total billed charges,1015.56,90,,,percent of total billed charges,Pays at 90% of total billed charges,1015.56,90,,,percent of total billed charges,Pays at 90% of total billed charges,677.04,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,821.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,770.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,677.04,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,910.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,910.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,999.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,748.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,914,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1038.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,1071.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,1094.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,733.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,677.04,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,677.04,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,677.04,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1015.56,90,,,percent of total billed charges,Pays at 90% of total billed charges,677.04,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,677.04,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1015.56,
OATS SET 8MM,2001405,CDM,272,RC,,,outpatient,,,1128.4,564.2,,1094.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,677.04,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,338.52,30,,,percent of total billed charges,Pays at 30% of total billed charges,1015.56,90,,,percent of total billed charges,Pays at 90% of total billed charges,1015.56,90,,,percent of total billed charges,Pays at 90% of total billed charges,677.04,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,821.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,770.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,677.04,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,910.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,910.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,999.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,748.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,914,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1038.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,1071.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,1094.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,733.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,677.04,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,677.04,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,677.04,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1015.56,90,,,percent of total billed charges,Pays at 90% of total billed charges,677.04,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,677.04,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1015.56,
OATS SET 10MM,2001406,CDM,272,RC,,,outpatient,,,1128.4,564.2,,1094.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,677.04,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,338.52,30,,,percent of total billed charges,Pays at 30% of total billed charges,1015.56,90,,,percent of total billed charges,Pays at 90% of total billed charges,1015.56,90,,,percent of total billed charges,Pays at 90% of total billed charges,677.04,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,821.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,770.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,677.04,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,910.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,910.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,999.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,748.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,914,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1038.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,1071.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,1094.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,733.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,677.04,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,677.04,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,677.04,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1015.56,90,,,percent of total billed charges,Pays at 90% of total billed charges,677.04,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,677.04,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1015.56,
RELOAD GIA 100,2001409,CDM,272,RC,,,outpatient,,,234.75,117.38,,227.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,211.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,211.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,160.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,189.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,189.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,155.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,190.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,215.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,223.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,227.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,152.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,211.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,211.28,
RELOAD GIA 10038l,2001410,CDM,272,RC,,,outpatient,,,243.5,121.75,,236.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,219.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,219.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,166.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,146.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,196.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,215.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,161.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,197.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,224.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,231.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,236.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,158.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,146.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,219.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,146.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,219.15,
RELOAD GIA 8038l,2001411,CDM,272,RC,,,outpatient,,,183.25,91.63,,177.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,164.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,125.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,148.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,168.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,174.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,177.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,119.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,164.93,
DELTA DRY CAST PADDING 2'',2001412,CDM,270,RC,,,outpatient,,,23,11.5,,22.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,20.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.8,90,
DELTA DRY CAST PADDING 3'',2001413,CDM,270,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,90,
AVENIR LATERAL STEM CEM 5,2001414,CDM,278,RC,,,outpatient,,,3144.5,1572.25,,3050.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,1886.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,943.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,2830.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,2830.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1886.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2287.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2146.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1886.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2538.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2538.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2786.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2084.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2547.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2892.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,2987.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,3050.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,2043.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,1886.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1886.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1886.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2830.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1886.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1886.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2830.05,
FEMORAL HEAD 28MM +0 12/14 COCR,2001415,CDM,278,RC,,,outpatient,,,1156.75,578.38,,1122.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,694.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,347.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,1041.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,1041.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,694.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,841.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,789.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,694.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,933.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,933.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1025,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,766.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,936.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1064.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,1098.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,1122.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,751.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,694.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,694.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,694.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1041.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,694.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,694.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1041.08,
CORKSCREW  SUTURE ANCHOR MINI,2001416,CDM,278,RC,,,outpatient,,,640.25,320.13,,621.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,576.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,576.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,465.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,436.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,516.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,516.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,567.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,424.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,518.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,589.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,608.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,621.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,416.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,576.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,576.23,
DRILL BIT 2.5MM CALIBRATED,2001417,CDM,272,RC,,,outpatient,,,191,95.5,,185.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,171.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,171.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,130.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,114.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,169.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,126.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,154.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,175.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,181.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,185.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,114.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,114.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,171.9,
DISTAL RAD PLATEVOLAR TI RROW RT 3H,2001418,CDM,278,RC,,,outpatient,,,1251.25,625.63,,1213.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,750.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1126.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,1126.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,750.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,910.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,853.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,750.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1010.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1010.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1108.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,829.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1013.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1151.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,1188.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,1213.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,813.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,750.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,750.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,750.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1126.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,750.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,750.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1126.13,
SCREW LO PRO TM SS 3.5X12MM,2001419,CDM,278,RC,,,outpatient,,,135,67.5,,130.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,81,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,121.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,81,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,92.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,81,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,124.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,130.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,81,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,81,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,81,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.5,
SCREW LO PRO TM SS 3.5X14MM,2001420,CDM,278,RC,,,outpatient,,,135,67.5,,130.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,81,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,121.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,81,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,92.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,81,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,124.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,130.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,81,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,81,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,81,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.5,
CIRCUIT  NIV/DISP EXHAL/PORT,2001421,CDM,270,RC,,,outpatient,,,31,15.5,,30.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,90,
SCREW LOCKING STARDRIVE  3.5MMX34MM,2001422,CDM,278,RC,,,outpatient,,,590.75,295.38,,573.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,354.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,531.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,531.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,354.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,429.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,403.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,354.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,476.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,476.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,523.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,391.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,478.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,543.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,561.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,573.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,383.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,354.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,354.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,354.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,531.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,354.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,354.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,531.68,
SCREW LOCKING STARDRIVE  3.5MMX38MM,2001423,CDM,278,RC,,,outpatient,,,590.75,295.38,,573.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,354.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,531.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,531.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,354.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,429.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,403.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,354.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,476.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,476.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,523.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,391.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,478.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,543.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,561.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,573.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,383.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,354.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,354.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,354.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,531.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,354.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,354.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,531.68,
SCREW CORTEX 3.5 SELF TAPPING 36MM,2001424,CDM,278,RC,,,outpatient,,,144,72,,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,116.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,136.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,129.6,
SCREW CORTEX 3.5 SELF TAPPING 60MM,2001425,CDM,278,RC,,,outpatient,,,144,72,,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,116.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,136.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,129.6,
DRILL BIT QUICK COUPLING 110MM GOLD,2001426,CDM,272,RC,,,outpatient,,,325.75,162.88,,315.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,195.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,293.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,293.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,195.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,237.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,222.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,195.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,262.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,288.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,215.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,263.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,299.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,309.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,315.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,211.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,195.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,293.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,195.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,195.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,293.18,
DRILL BIT QUICK COUPLING 165MM,2001427,CDM,272,RC,,,outpatient,,,199,99.5,,193.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,119.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,179.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,179.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,135.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,119.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,176.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,131.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,161.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,183.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,189.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,193.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,129.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,119.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,179.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,119.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,179.1,
DRILL BIT QUICK COUPLING 110MM,2001428,CDM,272,RC,,,outpatient,,,346,173,,335.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,207.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,311.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,311.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,236.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,207.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,279.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,279.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,306.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,229.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,280.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,318.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,328.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,335.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,224.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,207.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,311.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,207.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,311.4,
SCREW CANNULATED 4.0MMX50MM SHORT,2001429,CDM,278,RC,,,outpatient,,,434.5,217.25,,421.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,260.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,391.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,391.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,260.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,316.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,296.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,260.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,350.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,350.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,385.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,288.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,351.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,399.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,412.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,421.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,282.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,260.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,260.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,260.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,391.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,260.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,260.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,391.05,
GUIDE WIRE NON THREAD 1.25MM X150MM,2001430,CDM,272,RC,,,outpatient,,,126.25,63.13,,122.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,113.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,86.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,75.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,111.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,83.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,102.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,116.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,119.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,122.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,75.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,75.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,113.63,
DRILL BIT QUICK COUPLING 2.7MMX160MM,2001431,CDM,272,RC,,,outpatient,,,1877.75,938.88,,1821.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,1126.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,563.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,1689.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,1689.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,1126.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1366.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1281.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1126.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1515.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1515.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1663.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1244.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1520.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1727.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,1783.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,1821.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,1220.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,1126.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1126.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1126.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1689.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,1126.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1126.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1689.98,
PLATE LO PRO 3.5MM CURVED RECON,2001432,CDM,278,RC,,,outpatient,,,1407.5,703.75,,1365.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,844.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,422.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,1266.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,1266.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,844.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1024.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,960.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,844.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1136.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1136.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1247.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,933.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1140.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1294.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,1337.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,1365.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,914.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,844.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,844.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,844.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1266.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,844.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,844.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1266.75,
SCREW LOCKING STARDRIVE  3.5MMX30MM,2001433,CDM,278,RC,,,outpatient,,,590.75,295.38,,573.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,354.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,531.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,531.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,354.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,429.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,403.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,354.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,476.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,476.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,523.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,391.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,478.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,543.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,561.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,573.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,383.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,354.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,354.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,354.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,531.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,354.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,354.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,531.68,
SUTURE  POLYSORB 2-0 GS21 UNDYED POPS,2001434,CDM,272,RC,,,outpatient,,,10,5,,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,30,,,percent of total billed charges,Pays at 30% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,90,
PLATE DIST/MED/HUM 4HOL;E,2001444,CDM,278,RC,,,outpatient,,,2183,1091.5,,2117.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,1309.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,654.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,1964.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1964.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1309.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1588.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1489.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1309.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1762.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1762.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1934.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1447.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1768.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2008.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,2073.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2117.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,1418.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1309.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1309.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1309.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1964.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1309.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1309.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1964.7,
PLATE DIST/LAT/HUM 4HOLE/RT,2001445,CDM,278,RC,,,outpatient,,,2183,1091.5,,2117.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,1309.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,654.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,1964.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1964.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1309.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1588.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1489.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1309.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1762.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1762.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1934.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1447.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1768.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2008.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,2073.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2117.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,1418.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1309.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1309.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1309.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1964.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1309.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1309.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1964.7,
DRILL 2.0MMX122MM AO SHAFT,2001446,CDM,272,RC,,,outpatient,,,320.25,160.13,,310.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,192.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,288.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,288.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,192.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,233.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,218.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,192.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,258.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,258.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,283.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,212.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,259.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,294.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,304.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,310.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,208.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,192.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,288.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,192.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,192.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,288.23,
DRILL 2.6MMX122MM AO SHAFT,2001447,CDM,272,RC,,,outpatient,,,320.25,160.13,,310.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,192.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,288.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,288.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,192.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,233.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,218.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,192.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,258.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,258.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,283.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,212.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,259.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,294.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,304.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,310.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,208.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,192.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,288.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,192.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,192.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,288.23,
BLADE SCREWDRIVER,2001448,CDM,272,RC,,,outpatient,,,626.25,313.13,,607.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,375.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,563.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,563.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,375.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,455.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,427.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,375.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,505.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,505.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,554.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,415.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,507.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,576.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,594.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,607.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,407.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,375.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,375.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,375.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,563.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,375.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,375.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,563.63,
SCREW LOCKING T10/2.7MMX50MM,2001451,CDM,278,RC,,,outpatient,,,304.75,152.38,,295.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,274.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,274.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,207.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,245.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,245.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,270.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,202.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,246.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,280.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,289.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,295.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,198.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,274.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,274.28,
SCREW LOCKING T10/3.5MMX18/MM,2001452,CDM,278,RC,,,outpatient,,,304.75,152.38,,295.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,274.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,274.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,207.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,245.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,245.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,270.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,202.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,246.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,280.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,289.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,295.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,198.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,274.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,274.28,
SCREW LOCKING T10/3.5MMX26/MM,2001453,CDM,278,RC,,,outpatient,,,304.75,152.38,,295.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,274.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,274.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,207.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,245.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,245.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,270.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,202.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,246.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,280.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,289.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,295.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,198.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,274.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,274.28,
SCREW LOCKING T10/3.5MMX40/MM,2001454,CDM,278,RC,,,outpatient,,,304.75,152.38,,295.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,274.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,274.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,207.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,245.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,245.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,270.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,202.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,246.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,280.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,289.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,295.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,198.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,274.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,274.28,
SCREW LOCKING T10/3.5MMX50/MM,2001455,CDM,278,RC,,,outpatient,,,304.75,152.38,,295.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,274.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,274.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,207.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,245.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,245.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,270.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,202.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,246.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,280.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,289.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,295.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,198.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,274.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,274.28,
SCREW LOCKING T10/3.5MMX60/MM,2001456,CDM,278,RC,,,outpatient,,,304.75,152.38,,295.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,274.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,274.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,207.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,245.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,245.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,270.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,202.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,246.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,280.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,289.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,295.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,198.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,274.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,182.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,274.28,
SCREW BONE T10/3.5X16MM,2001457,CDM,278,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
SCREW BONE T10/3.5X18MM,2001458,CDM,278,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
SCREW BONE T10/3.5X22MM,2001459,CDM,278,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
SCREW BONE T10/3.5X26MM,2001460,CDM,278,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
SCREW BONE T10/3.5X28MM,2001461,CDM,278,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
SCREW BONE T10/3.5X30MM,2001462,CDM,278,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
SCREW BONE T10/3.5X34MM,2001463,CDM,278,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
SCREW BONE T10/3.5X24MM,2001464,CDM,278,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
DRILL BIT 1.5MM,2001465,CDM,272,RC,,,outpatient,,,359.5,179.75,,348.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,323.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,323.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,261.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,245.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,290.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,290.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,318.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,238.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,291.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,330.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,341.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,348.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,233.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,323.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,323.55,
BB TAK SMALL;,2001466,CDM,272,RC,,,outpatient,,,337,168.5,,326.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,202.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,303.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,303.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,245.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,230,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,202.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,272.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,272.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,298.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,223.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,272.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,310.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,320.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,326.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,219.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,202.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,303.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,202.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,303.3,
GUIDE WIRE TROCAR 1.6MM,2001467,CDM,272,RC,,,outpatient,,,90.25,45.13,,87.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,73.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,83.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,85.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,87.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,90,
SCREW LO PRO LOCK 2.0X10MM,2001468,CDM,278,RC,,,outpatient,,,247.25,123.63,,239.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,148.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,222.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,148.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,179.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,168.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,148.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,199.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,219.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,163.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,200.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,227.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,234.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,239.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,160.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,148.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,148.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,148.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,222.53,
SCREW LO PRO LOCK 2.0X11MM,2001469,CDM,278,RC,,,outpatient,,,247.25,123.63,,239.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,148.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,222.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,148.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,179.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,168.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,148.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,199.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,219.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,163.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,200.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,227.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,234.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,239.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,160.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,148.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,148.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,148.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,222.53,
T PLATE ROTATION CORRECTION 2.0MM 5 HOLE,2001470,CDM,278,RC,,,outpatient,,,1785.75,892.88,,1732.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,1071.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,535.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,1607.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1607.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1071.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1299.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1218.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1071.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1441.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1441.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1582.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1183.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1446.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1642.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,1696.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,1732.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,1160.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,1071.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1071.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1071.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1607.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1071.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1071.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1607.18,
CONNECTING BAR 3.0MM ANGLED,2001472,CDM,272,RC,,,outpatient,,,184,92,,178.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,110.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,165.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,125.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,110.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,163.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,149.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,169.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,174.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,178.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,119.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,110.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,110.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,165.6,
CLAMP HOLDING 1.25MM,2001473,CDM,272,RC,,,outpatient,,,1240.5,620.25,,1203.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,744.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,372.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,1116.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,1116.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,744.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,902.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,846.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,744.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1001.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1001.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1099.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,822.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1004.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1141.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,1178.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,1203.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,806.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,744.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,744.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,744.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1116.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,744.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,744.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1116.45,
CLAMP CONNECTING 3.0MM,2001474,CDM,272,RC,,,outpatient,,,1164,582,,1129.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,698.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,349.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,1047.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,1047.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,698.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,846.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,794.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,698.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,939.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,939.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1031.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,771.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,942.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1070.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,1105.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,1129.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,756.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,698.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,698.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,698.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1047.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,698.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,698.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1047.6,
CARBON FIBER VOA,2001475,CDM,272,RC,,,outpatient,,,145.5,72.75,,141.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,130.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,99.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,117.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,96.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,133.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,138.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,141.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.95,
SCREW VAL TI 2.0X10MM,2001476,CDM,278,RC,,,outpatient,,,314.75,157.38,,305.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,188.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,283.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,283.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,188.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,229.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,214.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,188.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,254.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,278.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,208.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,254.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,289.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,299.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,305.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,204.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,188.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,283.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,188.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,188.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,283.28,
K WIRE  1.25MM,2001477,CDM,272,RC,,,outpatient,,,1016.25,508.13,,985.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,609.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,304.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,914.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,914.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,609.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,739.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,693.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,609.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,820.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,820.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,900.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,673.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,823.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,934.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,965.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,985.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,660.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,609.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,609.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,609.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,914.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,609.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,609.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,914.63,
PLATE TIBIA 6HOLE LT PROXIMAL,2001479,CDM,278,RC,,,outpatient,,,3551.25,1775.63,,3444.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,2130.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1065.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,3196.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,3196.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,2130.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2583.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2423.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2130.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2866.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2866.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3146.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2354.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2876.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3267.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,3373.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,3444.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,2308.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,2130.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2130.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2130.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3196.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,2130.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2130.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3196.13,
DELTA DRY CAST PADDING 4,2001480,CDM,270,RC,,,outpatient,,,28.25,14.13,,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,90,
SCREW LOCKING 4MM L75,2001482,CDM,278,RC,,,outpatient,,,372.75,186.38,,361.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,223.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,335.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,335.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,223.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,254.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,223.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,300.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,300.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,330.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,247.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,301.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,342.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,354.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,361.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,242.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,223.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,335.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,223.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,223.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,335.48,
SCREW LOCKING 4MM L85,2001483,CDM,278,RC,,,outpatient,,,372.75,186.38,,361.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,223.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,335.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,335.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,223.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,254.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,223.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,300.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,300.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,330.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,247.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,301.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,342.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,354.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,361.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,242.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,223.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,335.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,223.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,223.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,335.48,
SCREW CORTEX 3.5MM L40MM,2001485,CDM,278,RC,,,outpatient,,,157,78.5,,152.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.3,
SCREW CORTEX 3.5MM L 55 MM,2001486,CDM,278,RC,,,outpatient,,,157,78.5,,152.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.3,
SCREW CORTEX 3.5MM L 80 MM,2001487,CDM,278,RC,,,outpatient,,,157,78.5,,152.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.3,
SCREW CORTEX 3.5MM L 85 MM,2001488,CDM,278,RC,,,outpatient,,,157,78.5,,152.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.3,
SCREW CORTEX 3.5MM L 95 MM,2001489,CDM,278,RC,,,outpatient,,,157,78.5,,152.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.3,
DRILL BIT LOCKING MED 3.1X238MM,2001490,CDM,270,RC,,,outpatient,,,524.5,262.25,,508.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,314.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,472.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,472.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,314.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,357.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,314.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,423.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,423.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,464.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,347.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,424.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,482.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,498.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,508.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,340.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,314.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,314.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,314.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,472.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,314.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,314.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,472.05,
STABLE FIXATOR,2001491,CDM,278,RC,,,outpatient,,,5255.75,2627.88,,5098.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,3153.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1576.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,4730.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,4730.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,3153.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3824.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3587.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3153.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4242.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4242.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4657.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3484.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4257.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4835.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,4992.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,5098.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,3416.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,3153.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3153.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3153.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4730.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,3153.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3153.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4730.18,
DRILL BIT QUICK RELEASE 2.0MM,2001492,CDM,272,RC,,,outpatient,,,393.25,196.63,,381.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,353.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,353.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,286.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,268.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,317.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,317.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,348.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,260.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,318.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,361.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,373.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,381.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,255.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,353.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,353.93,
DRIVER TIP HEX LOCKING GROOVE,2001493,CDM,272,RC,,,outpatient,,,761.5,380.75,,738.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,456.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,685.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,685.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,456.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,554.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,519.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,456.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,614.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,614.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,674.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,504.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,616.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,700.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,723.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,738.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,494.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,456.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,456.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,456.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,685.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,456.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,456.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,685.35,
SCREW LOCKING 2.3X18MM,2001494,CDM,278,RC,,,outpatient,,,294.5,147.25,,285.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,176.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,265.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,265.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,176.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,201,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,176.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,237.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,237.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,260.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,195.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,238.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,270.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,279.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,285.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,191.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,176.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,265.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,176.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,176.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,265.05,
SCREW LOCKING 2.3X20MM,2001495,CDM,278,RC,,,outpatient,,,294.5,147.25,,285.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,176.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,265.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,265.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,176.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,201,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,176.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,237.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,237.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,260.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,195.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,238.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,270.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,279.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,285.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,191.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,176.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,265.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,176.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,176.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,265.05,
SCREW LOCKING 2.3X22MM,2001496,CDM,278,RC,,,outpatient,,,294.5,147.25,,285.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,176.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,265.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,265.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,176.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,201,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,176.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,237.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,237.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,260.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,195.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,238.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,270.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,279.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,285.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,191.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,176.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,265.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,176.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,176.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,265.05,
DRILL BIT QUICK RELEASE 2.8MM,2001497,CDM,272,RC,,,outpatient,,,427,213.5,,414.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,256.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,384.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,384.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,256.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,310.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,291.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,256.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,344.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,344.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,378.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,283.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,345.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,392.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,405.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,414.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,277.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,256.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,256.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,256.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,384.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,256.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,256.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,384.3,
SCREW LOCKING HEXALOBE 3.5X10,2001498,CDM,278,RC,,,outpatient,,,409,204.5,,396.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,245.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,368.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,368.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,245.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,279.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,245.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,330.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,330.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,362.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,271.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,331.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,376.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,388.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,396.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,265.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,245.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,245.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,245.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,368.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,245.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,245.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,368.1,
SCREW LOCKING HEXALOBE 3.5X12,2001499,CDM,278,RC,,,outpatient,,,245.25,122.63,,237.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,147.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,220.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,220.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,147.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,167.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,147.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,197.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,217.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,162.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,198.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,225.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,232.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,237.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,159.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,147.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,220.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,147.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,147.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,220.73,
GUIDE WIRE .054X6,2001500,CDM,272,RC,,,outpatient,,,99.25,49.63,,96.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,89.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,80.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,91.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,94.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,96.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,90,
PLATE ACU LOC 2 VDR STD LING R,2001501,CDM,278,RC,,,outpatient,,,3447.75,1723.88,,3344.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,2068.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1034.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,3102.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,3102.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,2068.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2508.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2353.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2068.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2783.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2783.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3055.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2285.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2792.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3171.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,3275.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,3344.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,2241.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,2068.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2068.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2068.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3102.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,2068.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2068.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3102.98,
BUR 4.0 DIAMOND ROUND,2001502,CDM,272,RC,,,outpatient,,,325,162.5,,315.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,195,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,292.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,292.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,195,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,236.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,221.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,195,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,262.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,215.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,263.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,299,92,,,percent of total billed charges,Pays at 92% of total billed charges,308.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,315.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,211.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,195,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,292.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,195,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,195,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,292.5,
BUR 4.0 DIAMOND ROUND EX COURSE,2001503,CDM,272,RC,,,outpatient,,,325,162.5,,315.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,195,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,292.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,292.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,195,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,236.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,221.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,195,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,262.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,215.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,263.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,299,92,,,percent of total billed charges,Pays at 92% of total billed charges,308.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,315.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,211.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,195,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,292.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,195,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,195,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,292.5,
BUR 5.0 DIAMOND ROUND,2001504,CDM,272,RC,,,outpatient,,,325,162.5,,315.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,195,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,292.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,292.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,195,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,236.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,221.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,195,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,262.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,215.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,263.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,299,92,,,percent of total billed charges,Pays at 92% of total billed charges,308.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,315.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,211.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,195,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,292.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,195,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,195,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,292.5,
BUR 3.0 ROUND SOLID CARBIDE LONG,2001505,CDM,272,RC,,,outpatient,,,187.25,93.63,,181.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,168.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,127.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,151.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,165.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,124.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,151.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,172.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,177.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,181.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,168.53,
BUR 3.0 ROUND DIAMOND COURSE,2001506,CDM,272,RC,,,outpatient,,,669.5,334.75,,649.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,401.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,602.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,602.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,401.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,487.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,456.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,401.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,540.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,540.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,593.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,443.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,542.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,615.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,636.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,649.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,435.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,401.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,401.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,401.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,602.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,401.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,401.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,602.55,
BUR 2.0 SOLID CARBIDE LONG,2001507,CDM,272,RC,,,outpatient,,,93.5,46.75,,90.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,84.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,75.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,86.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,88.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,90.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,90,
BIT DRILL WIRE PASS 1.5,2001508,CDM,272,RC,,,outpatient,,,143.25,71.63,,138.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,128.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,97.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,94.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,116.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,131.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,136.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,138.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,128.93,
SAW BLADE SAGITTAL 2108,2001509,CDM,272,RC,,,outpatient,,,176,88,,170.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,116.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,142.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,161.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,170.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,158.4,
SAW BLADE RECIPROCATING,2001510,CDM,272,RC,,,outpatient,,,227,113.5,,220.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,136.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,204.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,204.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,154.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,136.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,183.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,201.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,150.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,183.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,208.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,215.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,220.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,147.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,136.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,204.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,136.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,204.3,
PSN TIB STM 5 DEG SZ F L,2001511,CDM,278,RC,,,outpatient,,,1909.25,954.63,,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1389.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1303.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1691.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1265.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1546.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1756.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,1813.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1241.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1718.33,
PSN ASF PS 10MM VE L 10-11EF,2001512,CDM,278,RC,,,outpatient,,,2470.75,1235.38,,2396.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1797.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1686.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1994.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1994.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2189.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1638.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2001.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2273.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,2347.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,2396.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,1605.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2223.68,
PSN FEM PS CMT CCR STD SZ 10L,2001513,CDM,278,RC,,,outpatient,,,4492,2246,,4357.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3268.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3065.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3625.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3625.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3980.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2978.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3638.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4132.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,4267.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,4357.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,2919.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4042.8,
LEEP READY KIT,2001520,CDM,272,RC,,,outpatient,,,176.75,88.38,,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,117.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,143.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,162.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,159.08,
RETURN PAD PAT LEEP,2001521,CDM,272,RC,,,outpatient,,,50.75,25.38,,49.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,41.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,46.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,48.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,49.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,90,
APPLICATOR FLEXTIP ARISTA,2001522,CDM,272,RC,,,outpatient,,,231,115.5,,224.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,138.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,207.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,138.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,157.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,138.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,186.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,204.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,153.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,187.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,212.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,219.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,224.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,150.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,138.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,138.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,138.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,207.9,
ABORBABLE HEMOSTAT ARISTA,2001523,CDM,272,RC,,,outpatient,,,614,307,,595.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,368.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,552.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,552.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,368.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,446.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,419.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,368.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,495.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,495.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,544.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,407.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,497.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,564.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,583.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,595.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,399.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,368.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,368.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,368.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,552.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,368.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,368.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,552.6,
CANNULA ENDOMETRIAL,2001524,CDM,272,RC,,,outpatient,,,39.5,19.75,,38.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,36.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,37.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,38.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.7,90,
PAR-THOROCENTESIS TRAY,2001525,CDM,272,RC,,,outpatient,,,154.5,77.25,,149.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,92.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,139.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,105.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,92.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,124.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,102.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,125.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,142.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,146.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,149.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,92.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,92.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,139.05,
INTRODUCER TACHEAL BOUGIE 15 FR,2001526,CDM,272,RC,,,outpatient,,,32.25,16.13,,31.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,29.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,29.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,30.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,31.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.35,90,
LINER 36 MM G7 NEUTRAL E1,2001527,CDM,278,RC,,,outpatient,,,2583,1291.5,,2505.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2324.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2324.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1879.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1762.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2085,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2085,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2288.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1712.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2092.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2376.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,2453.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2505.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,1678.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2324.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2324.7,
SHELL HOLE OSSEOTI 4G7,2001528,CDM,278,RC,,,outpatient,,,5707.25,2853.63,,5536.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,3424.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,5136.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,5136.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,3424.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4152.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3895.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3424.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4606.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4606.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5057.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3783.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4622.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5250.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,5421.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,5536.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,3709.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,3424.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3424.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3424.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5136.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,3424.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3424.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,5136.53,
BIOLEX DELTA FEM HEAD 36MM,2001529,CDM,278,RC,,,outpatient,,,1347.75,673.88,,1307.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1212.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,1212.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,980.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,919.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1087.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1087.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1194.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,893.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1091.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1239.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,1280.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,1307.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,876.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1212.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1212.98,
AVENIR MULLER STANDARD STIM3,2001530,CDM,278,RC,,,outpatient,,,3593.75,1796.88,,3485.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3234.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,3234.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2614.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2452.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2900.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2900.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3184.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2382.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2910.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3306.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,3414.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,3485.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,2335.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3234.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3234.38,
SCREW LO PRO TM SS 3.5X34MM CORT,2001531,CDM,278,RC,,,outpatient,,,157.75,78.88,,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,145.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.98,
SCREW LO PRO TM SS 3.5X38MM CORT,2001532,CDM,278,RC,,,outpatient,,,157.75,78.88,,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,145.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.98,
SCREW LO PRO TM SS 3.5X40MM CORT,2001533,CDM,278,RC,,,outpatient,,,157.75,78.88,,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,145.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.98,
SCREW LO PRO TM SS 3.5X44MM CORT,2001534,CDM,278,RC,,,outpatient,,,157.75,78.88,,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,145.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.98,
SCREW LO PRO TM SS 4.0x16mm CORT,2001535,CDM,278,RC,,,outpatient,,,157.75,78.88,,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,145.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.98,
SCREW LO PRO TM SS 4.0x38mm CORT,2001536,CDM,278,RC,,,outpatient,,,157.75,78.88,,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,145.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.98,
WASHER 7.0MM SS,2001537,CDM,278,RC,,,outpatient,,,144.75,72.38,,140.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,130.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,133.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.28,
DRILL BIT 2.0MM CALIBRATED,2001538,CDM,272,RC,,,outpatient,,,191,95.5,,185.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,171.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,171.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,130.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,114.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,169.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,126.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,154.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,175.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,181.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,185.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,114.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,114.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,171.9,
PLATE LOCKING DIS FIBULA,2001539,CDM,278,RC,,,outpatient,,,1785.75,892.88,,1732.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,1071.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,535.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,1607.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1607.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1071.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1299.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1218.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1071.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1441.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1441.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1582.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1183.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1446.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1642.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,1696.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,1732.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,1160.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,1071.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1071.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1071.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1607.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1071.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1071.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1607.18,
PLATE LOCKING THIRD TUBULAR,2001540,CDM,278,RC,,,outpatient,,,505.5,252.75,,490.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,303.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,454.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,454.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,303.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,367.8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,345,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,303.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,408.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,408.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,447.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,335.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,409.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,465.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,480.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,490.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,328.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,303.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,303.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,303.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,454.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,303.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,303.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,454.95,
SCREW LO PRO LOCK 2.7X12MM,2001541,CDM,278,RC,,,outpatient,,,258.5,129.25,,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,176.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,229.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,171.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,209.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,237.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,245.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,232.65,
PSN ALL POLY PAT 38MM PLY,2001542,CDM,278,RC,,,outpatient,,,674,337,,653.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,606.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,606.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,490.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,460.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,544.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,544.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,597.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,446.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,545.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,620.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,640.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,653.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,438.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,606.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,606.6,
PSN ASF CR 10MM PLY R7-12GH,2001543,CDM,278,RC,,,outpatient,,,1347.75,673.88,,1307.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1212.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,1212.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,980.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,919.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1087.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1087.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1194.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,893.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1091.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1239.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,1280.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,1307.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,876.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1212.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1212.98,
PSN TIB STM 5 PEG S2 GR,2001544,CDM,278,RC,,,outpatient,,,1909.25,954.63,,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1389.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1303.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1691.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1265.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1546.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1756.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,1813.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1241.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1718.33,
PSN FEM CR CMT CCR STD SZ9R,2001545,CDM,278,RC,,,outpatient,,,4492,2246,,4357.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3268.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3065.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3625.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3625.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3980.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2978.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3638.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4132.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,4267.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,4357.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,2919.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4042.8,
DRILL BIT 5.0,2001546,CDM,272,RC,,,outpatient,,,133,66.5,,129.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,119.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,90.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,79.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,117.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,88.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,107.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,122.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,126.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,129.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,79.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,79.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,119.7,
DRILL BIT 4.8,2001547,CDM,272,RC,,,outpatient,,,133,66.5,,129.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,119.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,90.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,79.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,117.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,88.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,107.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,122.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,126.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,129.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,79.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,79.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,119.7,
DRILL BIT 4.5,2001548,CDM,272,RC,,,outpatient,,,128.5,64.25,,124.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,87.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,85.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,104.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,118.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,122.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,124.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,115.65,
DRILL BIT 4.0,2001549,CDM,272,RC,,,outpatient,,,128.5,64.25,,124.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,87.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,85.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,104.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,118.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,122.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,124.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,115.65,
DRILL BIT 3.5,2001550,CDM,272,RC,,,outpatient,,,128.5,64.25,,124.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,87.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,85.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,104.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,118.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,122.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,124.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,115.65,
DRILL BIT 3.2,2001551,CDM,272,RC,,,outpatient,,,128.5,64.25,,124.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,87.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,85.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,104.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,118.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,122.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,124.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,115.65,
DRILL BIT 2.7,2001552,CDM,272,RC,,,outpatient,,,121.75,60.88,,118.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,98.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,115.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,118.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,109.58,
DRILL BIT 2.5,2001553,CDM,272,RC,,,outpatient,,,121.75,60.88,,118.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,98.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,115.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,118.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,109.58,
DRILL BIT 2.0,2001554,CDM,272,RC,,,outpatient,,,121.75,60.88,,118.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,98.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,115.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,118.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,109.58,
DRILL BIT 1.5,2001555,CDM,272,RC,,,outpatient,,,121.75,60.88,,118.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,98.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,115.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,118.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,109.58,
DRILL BIT 2.7MM CANN,2001556,CDM,272,RC,,,outpatient,,,983,491.5,,953.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,589.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,294.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,884.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,884.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,589.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,715.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,670.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,589.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,793.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,793.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,871.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,651.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,796.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,904.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,933.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,953.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,638.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,589.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,884.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,589.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,589.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,884.7,
SCREW CORTEX 2.7X16MM,2001557,CDM,278,RC,,,outpatient,,,145.5,72.75,,141.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,130.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,99.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,117.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,96.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,133.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,138.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,141.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.95,
SCREW CORTEX 3.5MMX12MM,2001558,CDM,278,RC,,,outpatient,,,277,138.5,,268.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,166.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,249.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,249.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,189.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,166.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,223.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,245.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,183.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,224.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,254.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,263.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,268.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,180.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,166.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,249.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,166.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,249.3,
SCREW CORTEX 3.5MMX14MM,2001559,CDM,278,RC,,,outpatient,,,277,138.5,,268.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,166.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,249.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,249.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,189.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,166.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,223.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,245.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,183.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,224.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,254.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,263.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,268.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,180.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,166.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,249.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,166.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,249.3,
SCREW CORTEX 3.5X16MM,2001560,CDM,278,RC,,,outpatient,,,94,47,,91.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,84.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,64.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,62.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,76.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,86.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,89.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,91.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.4,90,
SCREW CORTEX 3.5X16MM,2001561,CDM,278,RC,,,outpatient,,,262.25,131.13,,254.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,157.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,236.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,236.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,178.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,157.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,211.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,211.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,232.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,173.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,212.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,241.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,249.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,254.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,170.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,157.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,236.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,157.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,236.03,
SCREW CORTEX 2.7X18MM,2001562,CDM,278,RC,,,outpatient,,,262.25,131.13,,254.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,157.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,236.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,236.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,178.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,157.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,211.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,211.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,232.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,173.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,212.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,241.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,249.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,254.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,170.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,157.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,236.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,157.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,236.03,
PLATE LATERAL DIST FIB LCP,2001563,CDM,278,RC,,,outpatient,,,1378.5,689.25,,1337.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,827.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,413.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,1240.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,1240.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,827.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1003,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,940.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,827.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1112.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1112.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1221.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,913.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1116.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1268.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,1309.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,1337.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,896.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,827.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,827.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,827.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1240.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,827.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,827.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1240.65,
SCREW CANN 4.0X40MM,2001564,CDM,278,RC,,,outpatient,,,441.25,220.63,,428.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,264.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,397.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,397.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,264.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,321.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,301.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,264.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,356.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,356.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,390.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,292.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,357.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,405.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,419.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,428.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,286.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,264.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,264.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,264.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,397.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,264.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,264.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,397.13,
SCREW CANN 4.0X50MM,2001565,CDM,278,RC,,,outpatient,,,441.25,220.63,,428.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,264.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,397.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,397.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,264.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,321.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,301.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,264.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,356.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,356.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,390.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,292.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,357.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,405.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,419.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,428.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,286.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,264.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,264.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,264.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,397.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,264.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,264.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,397.13,
WASHER 7.0MM,2001566,CDM,278,RC,,,outpatient,,,112.5,56.25,,109.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,101.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,103.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,109.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,101.25,
GUIDE WIRE 1.25 NON THREAD,2001567,CDM,278,RC,,,outpatient,,,124,62,,120.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,111.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,84.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,74.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,109.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,82.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,100.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,114.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,117.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,120.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,74.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,74.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,111.6,
PSN FEMALE CMT CCR SZ6 L,2001568,CDM,278,RC,,,outpatient,,,4492,2246,,4357.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1347.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3268.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3065.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3625.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3625.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3980.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2978.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3638.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4132.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,4267.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,4357.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,2919.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4042.8,
PSN TIB 5 DEGREE SZ D L,2001569,CDM,278,RC,,,outpatient,,,1909.25,954.63,,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,572.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1389.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1303.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1691.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1265.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1546.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1756.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,1813.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1241.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1718.33,
PSN ASF PS 10MM VE L,2001570,CDM,278,RC,,,outpatient,,,2470.75,1235.38,,2396.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,741.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1797.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1686.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1994.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1994.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2189.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1638.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2001.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2273.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,2347.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,2396.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,1605.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2223.68,
BIOMET BONE CEMENT R 1X40US,2001571,CDM,272,RC,,,outpatient,,,117,58.5,,113.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,105.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,70.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,107.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,111.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,70.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,70.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,105.3,
SUTURE  POLYSORB  GS21 VIOILET POPS,2001572,CDM,272,RC,,,outpatient,,,9.5,4.75,,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,90,
SUTURE  POLYSORB 2.0  GS21 VIOILET POPS,2001573,CDM,272,RC,,,outpatient,,,11,5.5,,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,90,
PSN ASN PS 10MM VE R 6-9 GH,2001574,CDM,278,RC,,,outpatient,,,2387,1193.5,,2315.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2148.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,2148.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1736.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1629.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1926.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1926.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2115.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1582.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1933.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2196.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,2267.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,2315.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,1551.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2148.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2148.3,
PSN FEM PS CMT CCR STD SZ9R,2001575,CDM,278,RC,,,outpatient,,,4340,2170,,4209.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3906,90,,,percent of total billed charges,Pays at 90% of total billed charges,3906,90,,,percent of total billed charges,Pays at 90% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3157.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2962.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3503.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3503.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3845.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2877.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3515.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3992.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,4123,95,,,percent of total billed charges,Pays at 95% of total billed charges,4209.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,2821,65,,,percent of total billed charges,Pays at 65% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3906,90,,,percent of total billed charges,Pays at 90% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3906,
G7 VIT E HIGH WALL LNR 36MM D,2001576,CDM,278,RC,,,outpatient,,,2495,1247.5,,2420.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,1497,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2245.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,2245.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,1497,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1815.36,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1702.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1497,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2013.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2013.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2210.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1654.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2020.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2295.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,2370.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,2420.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,1621.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,1497,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1497,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1497,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2245.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,1497,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1497,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2245.5,
FEM HD DELTA CERAMIC 36/3MM,2001577,CDM,278,RC,,,outpatient,,,1302,651,,1262.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,781.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1171.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1171.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,781.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,947.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,888.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,781.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1050.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1050.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1153.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,863.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1054.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1197.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,1236.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,1262.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,846.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,781.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,781.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,781.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1171.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,781.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,781.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1171.8,
ECHO PO FMRL NC 10X130MM,2001578,CDM,278,RC,,,outpatient,,,3472,1736,,3367.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3124.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,3124.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2526.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2369.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2802.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2802.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3076.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2301.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2812.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3194.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,3298.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,3367.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,2256.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3124.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2083.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3124.8,
PSN ASF 10MM PLY 3-5 CD,2001579,CDM,278,RC,,,outpatient,,,1302,651,,1262.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,781.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1171.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1171.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,781.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,947.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,888.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,781.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1050.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1050.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1153.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,863.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1054.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1197.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,1236.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,1262.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,846.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,781.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,781.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,781.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1171.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,781.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,781.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1171.8,
PSN ALL POLY PAT PLY,2001580,CDM,278,RC,,,outpatient,,,651,325.5,,631.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,585.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,585.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,473.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,444.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,525.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,525.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,576.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,431.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,527.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,598.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,618.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,631.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,423.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,585.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,390.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,585.9,
PSN FEM PS CMT CCR NRW SL,2001581,CDM,278,RC,,,outpatient,,,4340,2170,,4209.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3906,90,,,percent of total billed charges,Pays at 90% of total billed charges,3906,90,,,percent of total billed charges,Pays at 90% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3157.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2962.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3503.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3503.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3845.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2877.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3515.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3992.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,4123,95,,,percent of total billed charges,Pays at 95% of total billed charges,4209.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,2821,65,,,percent of total billed charges,Pays at 65% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3906,90,,,percent of total billed charges,Pays at 90% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3906,
PSN TIB STM 5 DEG SZ DL,2001582,CDM,278,RC,,,outpatient,,,1844.5,922.25,,1789.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1660.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1660.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1342.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1258.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1488.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1488.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1634.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1222.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1494.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1696.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,1752.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,1789.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,1198.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1660.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1660.05,
PSN STRAIGHT HYBST 14X30M,2001583,CDM,278,RC,,,outpatient,,,1736,868,,1683.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,1041.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1562.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,1562.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,1041.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1263.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1184.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1041.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1401.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1401.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1538.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1150.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1406.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1597.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,1649.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,1683.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,1128.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,1041.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1041.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1041.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1562.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,1041.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1041.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1562.4,
SCREW LOCKING CORTEX 3.5X14MM,2001584,CDM,278,RC,,,outpatient,,,90.75,45.38,,88.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,81.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,60.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,73.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,83.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,86.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,88.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.45,90,
SCREW LOCKING CORTEX 3.5X12MM,2001585,CDM,278,RC,,,outpatient,,,65,32.5,,63.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,52.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,59.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39,90,
SCREW LOCKING CORTEX 3.5X16MM,2001586,CDM,278,RC,,,outpatient,,,74.75,37.38,,72.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,49.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,60.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,68.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,72.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,90,
SCREW NON LOCKING CORTEX 4.0X16MM,2001587,CDM,278,RC,,,outpatient,,,65,32.5,,63.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,52.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,59.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,39,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39,90,
PLATE 2.7 3.5 VARI ANGLE LCP TIB,2001588,CDM,278,RC,,,outpatient,,,3244.75,1622.38,,3147.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,1946.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,973.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,2920.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,2920.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1946.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2360.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2214.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1946.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2619.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2619.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2875.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2151.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2628.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2985.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,3082.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,3147.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,2109.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,1946.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1946.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1946.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2920.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1946.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1946.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2920.28,
SCREW 2.7 VARI ANGLE T8 10MM,2001589,CDM,278,RC,,,outpatient,,,304.5,152.25,,295.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,274.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,274.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,207.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,245.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,245.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,269.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,201.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,246.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,280.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,289.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,295.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,197.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,274.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,274.05,
SCREW 2.7 VARI ANGLE T8 30MM,2001590,CDM,278,RC,,,outpatient,,,304.5,152.25,,295.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,274.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,274.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,207.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,245.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,245.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,269.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,201.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,246.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,280.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,289.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,295.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,197.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,274.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,274.05,
PSN FEM CR CMT CCR NRW SZ81,2001591,CDM,278,RC,,,outpatient,,,4492,2246,,4357.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1347.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3268.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3065.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3625.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3625.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3980.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2978.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3638.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4132.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,4267.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,4357.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,2919.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4042.8,
PSN ASF CR 10MM VE L 3-9CD,2001592,CDM,278,RC,,,outpatient,,,2470.75,1235.38,,2396.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,741.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1797.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1686.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1994.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1994.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2189.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1638.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2001.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2273.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,2347.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,2396.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,1605.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2223.68,
PSN TIB STM 5 DEG SZ DL,2001593,CDM,278,RC,,,outpatient,,,1909.25,954.63,,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,572.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1389.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1303.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1691.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1265.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1546.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1756.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,1813.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1241.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1718.33,
SCREW 2.7 VARI ANGLE T8 36MM,2001594,CDM,278,RC,,,outpatient,,,304.5,152.25,,295.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,274.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,274.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,207.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,245.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,245.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,269.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,201.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,246.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,280.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,289.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,295.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,197.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,274.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,274.05,
SCREW 2.7 VARI ANGLE T8 40MM,2001595,CDM,278,RC,,,outpatient,,,304.5,152.25,,295.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,274.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,274.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,207.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,245.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,245.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,269.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,201.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,246.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,280.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,289.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,295.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,197.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,274.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,182.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,274.05,
SCREW 2.7MM CORTEX T8,2001596,CDM,278,RC,,,outpatient,,,163.75,81.88,,158.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,147.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,147.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,111.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,98.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,145.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,108.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,132.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,150.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,155.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,158.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,98.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,98.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,147.38,
SCREW 3.5 VA CORTEX T15 30MM,2001597,CDM,278,RC,,,outpatient,,,322,161,,312.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,193.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,289.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,289.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,193.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,234.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,219.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,193.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,259.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,285.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,213.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,260.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,296.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,305.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,312.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,209.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,193.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,289.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,193.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,193.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,289.8,
SCREW 3.5 VA CORTEX T15 26MM,2001598,CDM,278,RC,,,outpatient,,,154.25,77.13,,149.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,92.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,138.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,138.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,105.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,92.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,124.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,102.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,124.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,141.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,146.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,149.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,92.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,92.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,138.83,
SCREW 3.5 VA CORTEX T15 30MM,2001599,CDM,278,RC,,,outpatient,,,154.25,77.13,,149.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,92.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,138.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,138.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,105.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,92.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,124.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,102.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,124.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,141.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,146.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,149.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,92.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,92.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,138.83,
DRILL BIT  2.5  QUICK COUPLING 180MM,2001600,CDM,270,RC,,,outpatient,,,173,86.5,,167.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,155.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,118.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,153.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,140.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,159.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,164.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,167.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,155.7,
DRILL BIT  2.8 CALIBRATED,2001601,CDM,270,RC,,,outpatient,,,274.75,137.38,,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.28,
SCREW LO PRO LOCK 4.0X55MM,2001609,CDM,278,RC,,,outpatient,,,157.75,78.88,,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,145.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.98,
SCREW LO PRO LOCK 4.0X60MM,2001610,CDM,278,RC,,,outpatient,,,157.75,78.88,,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,145.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.98,
SCREW LO PRO LOCK 4.0X30MM,2001611,CDM,278,RC,,,outpatient,,,363.75,181.88,,352.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,218.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,327.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,327.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,218.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,264.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,248.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,218.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,293.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,293.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,322.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,241.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,294.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,334.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,345.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,352.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,236.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,218.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,327.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,218.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,218.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,327.38,
PLATE DISTAL FIBULA,2001612,CDM,278,RC,,,outpatient,,,1628.5,814.25,,1579.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,488.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,1465.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,1465.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1184.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1111.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1314.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1314.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1443.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1079.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1319.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1498.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,1547.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,1579.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,1058.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1465.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1465.65,
PLATE LOCKING MED HOOK,2001613,CDM,278,RC,,,outpatient,,,1853,926.5,,1797.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,1111.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,555.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,1667.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1667.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1111.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1348.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1264.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1111.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1495.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1495.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1641.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1228.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1500.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1704.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,1760.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,1797.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,1204.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,1111.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1111.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1111.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1667.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1111.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1111.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1667.7,
FIBERTAK DISP KIT,2001614,CDM,278,RC,,,outpatient,,,617.75,308.88,,599.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,370.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,555.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,555.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,370.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,449.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,421.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,370.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,498.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,498.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,547.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,409.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,500.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,568.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,586.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,599.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,401.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,370.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,555.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,370.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,370.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,555.98,
FIBERTAK SUTURE ANCHOR,2001615,CDM,278,RC,,,outpatient,,,1044.75,522.38,,1013.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,626.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,940.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,940.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,626.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,760.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,713.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,626.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,843.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,843.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,925.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,692.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,846.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,961.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,992.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,1013.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,679.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,626.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,626.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,626.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,940.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,626.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,626.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,940.28,
SCREW LO PRO LOCK 2.7X20MM,2001616,CDM,278,RC,,,outpatient,,,202.75,101.38,,196.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,138.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,163.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,179.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,134.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,164.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,186.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,192.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,196.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,182.48,
SCREW LO PRO LOCK 2.7X22MM,2001617,CDM,278,RC,,,outpatient,,,202.75,101.38,,196.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,138.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,163.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,179.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,134.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,164.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,186.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,192.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,196.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,182.48,
SCREW LO PRO LOCK 2.7X10MM,2001618,CDM,278,RC,,,outpatient,,,258.5,129.25,,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,176.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,229.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,171.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,209.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,237.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,245.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,232.65,
SCREW LO PRO LOCK 35X24MM,2001619,CDM,278,RC,,,outpatient,,,157.75,78.88,,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,145.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,153.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.98,
DRILL BIT 2.5MM,2001620,CDM,278,RC,,,outpatient,,,213.5,106.75,,207.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,192.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,192.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,145.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,172.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,189.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,141.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,172.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,196.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,202.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,207.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,138.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,192.15,
DRILL BIT 3.MM,2001621,CDM,278,RC,,,outpatient,,,258.5,129.25,,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,176.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,229.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,171.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,209.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,237.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,245.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,250.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,155.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,232.65,
PLATE VAR ANGLE 4 HOLE RT,2001622,CDM,278,RC,,,outpatient,,,3358.5,1679.25,,3257.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,2015.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1007.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,3022.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,3022.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2015.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2443.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2292.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2015.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2710.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2710.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2975.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2226.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2720.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3089.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,3190.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,3257.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,2183.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,2015.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2015.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2015.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3022.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2015.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2015.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3022.65,
SCREW METAPHYSEAL 2.7X34MM,2001623,CDM,278,RC,,,outpatient,,,203,101.5,,196.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,182.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,138.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,163.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,179.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,134.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,164.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,186.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,192.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,196.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,182.7,
SCREW CANN 28X4.0MM,2001624,CDM,278,RC,,,outpatient,,,434.5,217.25,,421.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,260.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,391.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,391.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,260.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,316.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,296.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,260.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,350.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,350.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,385.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,288.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,351.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,399.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,412.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,421.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,282.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,260.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,260.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,260.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,391.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,260.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,260.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,391.05,
SCREW ANGLE VAR 3.5X26MM,2001625,CDM,278,RC,,,outpatient,,,333.5,166.75,,323.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,300.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,300.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,227.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,269.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,295.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,221.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,270.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,306.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,316.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,323.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,216.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,300.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,300.15,
SCREW ANGLE VAR 2.7X18MM,2001626,CDM,278,RC,,,outpatient,,,315.25,157.63,,305.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,283.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,283.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,229.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,215.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,254.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,279.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,209.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,255.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,290.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,299.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,305.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,204.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,283.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,283.73,
SCREW ANGLE VAR 2.7X24MM,2001627,CDM,278,RC,,,outpatient,,,315.25,157.63,,305.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,283.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,283.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,229.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,215.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,254.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,279.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,209.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,255.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,290.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,299.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,305.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,204.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,283.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,283.73,
SCREW ANGLE VAR 2.7X30MM,2001628,CDM,278,RC,,,outpatient,,,315.25,157.63,,305.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,283.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,283.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,229.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,215.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,254.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,279.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,209.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,255.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,290.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,299.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,305.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,204.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,283.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,283.73,
SCREW ANGLE VAR 2.7X34MM,2001629,CDM,278,RC,,,outpatient,,,315.25,157.63,,305.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,283.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,283.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,229.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,215.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,254.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,279.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,209.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,255.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,290.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,299.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,305.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,204.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,283.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,189.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,283.73,
SCREW  VAR ANGLE 3.5X20MM,2001630,CDM,278,RC,,,outpatient,,,159.75,79.88,,154.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,143.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,143.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,109.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,95.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,105.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,129.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,146.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,151.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,154.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,95.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,95.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,143.78,
SCREW  VAR ANGLE 3.5X24MM,2001631,CDM,278,RC,,,outpatient,,,159.75,79.88,,154.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,143.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,143.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,109.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,95.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,105.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,129.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,146.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,151.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,154.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,95.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,95.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,143.78,
DRILL BIT 2.0MM,2001632,CDM,272,RC,,,outpatient,,,330,165,,320.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,198,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99,30,,,percent of total billed charges,Pays at 30% of total billed charges,297,90,,,percent of total billed charges,Pays at 90% of total billed charges,297,90,,,percent of total billed charges,Pays at 90% of total billed charges,198,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,240.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,225.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,198,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,266.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,266.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,292.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,218.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,267.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,303.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,313.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,320.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,214.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,198,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297,90,,,percent of total billed charges,Pays at 90% of total billed charges,198,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,198,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,297,
DRILL BIT 2.5MMX180MM GOLD,2001633,CDM,272,RC,,,outpatient,,,178.25,89.13,,172.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,160.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,160.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,121.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,106.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,157.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,118.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,144.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,163.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,169.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,172.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,115.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,106.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,160.43,
FLIPCUTTER,2001634,CDM,272,RC,,,outpatient,,,932.5,466.25,,904.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,559.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,279.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,839.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,839.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,559.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,678.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,636.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,559.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,752.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,752.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,826.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,618.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,755.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,857.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,885.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,904.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,606.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,559.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,559.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,559.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,839.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,559.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,559.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,839.25,
SCREW BC 10XX20MM,2001635,CDM,272,RC,,,outpatient,,,662.75,331.38,,642.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,397.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,596.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,596.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,397.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,482.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,452.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,397.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,534.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,534.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,587.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,439.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,536.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,609.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,629.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,642.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,430.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,397.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,397.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,397.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,596.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,397.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,397.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,596.48,
PSN TIB STM 5 DEG SZ H L,2001636,CDM,278,RC,,,outpatient,,,1909.25,954.63,,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1389.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1303.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1691.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1265.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1546.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1756.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,1813.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1241.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1718.33,
PSN MC VE ASF L 10MM 8-11,2001637,CDM,278,RC,,,outpatient,,,2470.75,1235.38,,2396.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1797.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1686.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1994.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1994.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2189.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1638.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2001.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2273.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,2347.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,2396.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,1605.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2223.68,
PSN FEM CR CMT CCR STD SZ 10L,2001638,CDM,278,RC,,,outpatient,,,4492,2246,,4357.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3268.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3065.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3625.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3625.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3980.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2978.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3638.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4132.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,4267.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,4357.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,2919.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4042.8,
IV TUBING 10 DROP PRIME FOR NUC-MED,2001639,CDM,272,RC,,,outpatient,,,16,8,,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.6,90,
FIBERTAK SUTURE ANCHOR,2001640,CDM,278,RC,,,outpatient,,,943.5,471.75,,915.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,566.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,283.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,849.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,849.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,566.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,686.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,643.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,566.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,761.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,761.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,836.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,625.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,764.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,868.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,896.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,915.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,613.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,566.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,566.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,566.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,849.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,566.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,566.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,849.15,
FIBERTAK DISP KIT,2001641,CDM,272,RC,,,outpatient,,,393.25,196.63,,381.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,353.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,353.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,286.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,268.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,317.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,317.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,348.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,260.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,318.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,361.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,373.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,381.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,255.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,353.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,353.93,
HYDROSET XT 5CC,2001642,CDM,270,RC,,,outpatient,,,4097.25,2048.63,,3974.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,2458.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1229.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,3687.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,3687.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,2458.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2981.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2796.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2458.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3307.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3307.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3630.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2716.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3318.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3769.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,3892.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,3974.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,2663.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,2458.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2458.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2458.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3687.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,2458.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2458.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3687.53,
SAW BLADE,2001643,CDM,272,RC,,,outpatient,,,112.75,56.38,,109.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,101.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,103.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,107.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,109.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,101.48,
SUTURE  SURGILON GS 22 POPS,2001644,CDM,272,RC,,,outpatient,,,6.25,3.13,,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,90,
SUTURE 3.0 SURGILON V-20 POPS,2001645,CDM,272,RC,,,outpatient,,,6.25,3.13,,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,90,
PSN FEM PS CMT CCR NRW SZ8 R,2001646,CDM,278,RC,,,outpatient,,,4340,2170,,4209.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3906,90,,,percent of total billed charges,Pays at 90% of total billed charges,3906,90,,,percent of total billed charges,Pays at 90% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3157.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2962.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3503.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3503.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3845.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2877.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3515.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3992.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,4123,95,,,percent of total billed charges,Pays at 95% of total billed charges,4209.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,2821,65,,,percent of total billed charges,Pays at 65% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3906,90,,,percent of total billed charges,Pays at 90% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3906,
G7 OSSEOTI 4 HOLE SHELL 56M F,2001647,CDM,278,RC,,,outpatient,,,5517.25,2758.63,,5351.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,3310.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4965.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4965.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,3310.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4014.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3765.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3310.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4453.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4453.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4888.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3657.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4468.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5075.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,5241.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,5351.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,3586.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,3310.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3310.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3310.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4965.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,3310.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3310.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4965.53,
G7  VIT E  HIGH WALL LNR 36MM F,2001648,CDM,278,RC,,,outpatient,,,2583,1291.5,,2505.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2324.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2324.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1879.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1762.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2085,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2085,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2288.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1712.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2092.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2376.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,2453.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2505.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,1678.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2324.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2324.7,
PSN TIB STM 5 DEG SZ C L,2001649,CDM,278,RC,,,outpatient,,,1844.5,922.25,,1789.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1660.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1660.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1342.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1258.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1488.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1488.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1634.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1222.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1494.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1696.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,1752.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,1789.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,1198.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1660.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1106.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1660.05,
PSN FEM PS CMT CCR NRW SZ4 L,2001650,CDM,278,RC,,,outpatient,,,4340,2170,,4209.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3906,90,,,percent of total billed charges,Pays at 90% of total billed charges,3906,90,,,percent of total billed charges,Pays at 90% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3157.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2962.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3503.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3503.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3845.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2877.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3515.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3992.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,4123,95,,,percent of total billed charges,Pays at 95% of total billed charges,4209.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,2821,65,,,percent of total billed charges,Pays at 65% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3906,90,,,percent of total billed charges,Pays at 90% of total billed charges,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2604,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3906,
VOLAR DR PLATE SMARTLOCK RROW LT,2001651,CDM,278,RC,,,outpatient,,,2281,1140.5,,2212.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,1368.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,684.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,2052.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,2052.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,1368.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1659.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1556.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1368.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1841.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1841.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2021.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1512.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1847.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2098.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,2166.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,2212.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,1482.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,1368.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1368.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1368.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2052.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,1368.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1368.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2052.9,
BLADE SCREWDRIVER T 8 AO,2001652,CDM,270,RC,,,outpatient,,,692.62,346.31,,671.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,415.57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.79,30,,,percent of total billed charges,Pays at 30% of total billed charges,623.36,90,,,percent of total billed charges,Pays at 90% of total billed charges,623.36,90,,,percent of total billed charges,Pays at 90% of total billed charges,415.57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,503.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,472.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,415.57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,559.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,559.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,613.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,459.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,561.02,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,637.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,657.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,671.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,450.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,415.57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,415.57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,415.57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,623.36,90,,,percent of total billed charges,Pays at 90% of total billed charges,415.57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,415.57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,623.36,
KIT DISP SHORT 2.9MM,2001653,CDM,272,RC,,,outpatient,,,542.5,271.25,,526.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,325.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,488.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,488.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,325.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,394.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,370.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,325.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,437.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,437.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,480.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,359.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,439.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,499.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,515.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,526.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,352.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,325.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,325.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,325.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,488.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,325.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,325.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,488.25,
IMPLANT SYSTEM DISTAL BICEPS,2001654,CDM,278,RC,,,outpatient,,,2636.75,1318.38,,2557.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,1582.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,791.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,2373.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,2373.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,1582.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1918.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1799.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1582.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2128.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2128.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2336.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1748.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2135.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2425.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,2504.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,2557.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,1713.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,1582.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1582.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1582.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2373.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,1582.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1582.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2373.08,
SUTURE ANCHOR SWIVELOCK TENDESIS,2001655,CDM,278,RC,,,outpatient,,,1349.75,674.88,,1309.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,809.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,404.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,1214.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,1214.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,809.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,982.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,921.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,809.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1089.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1089.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1196.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,894.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1093.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1241.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,1282.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,1309.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,877.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,809.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,809.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,809.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1214.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,809.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,809.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1214.78,
SUTURE ANCHOR SWIVELOCK TENDESIS,2001656,CDM,278,RC,,,outpatient,,,1349.75,674.88,,1309.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,809.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,404.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,1214.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,1214.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,809.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,982.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,921.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,809.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1089.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1089.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1196.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,894.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1093.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1241.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,1282.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,1309.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,877.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,809.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,809.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,809.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1214.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,809.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,809.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1214.78,
BIOCOMPSITE PUSHLOCH ANCHOR,2001657,CDM,278,RC,,,outpatient,,,1241.25,620.63,,1204.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,744.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,372.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,1117.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,1117.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,744.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,903.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,847.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,744.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1001.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1001.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1099.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,822.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1005.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1141.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,1179.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,1204.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,806.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,744.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,744.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,744.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1117.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,744.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,744.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1117.13,
REAMER HEADED 8.5 MM PILOT,2001658,CDM,278,RC,,,outpatient,,,445,222.5,,431.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,267,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,400.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,267,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,323.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,303.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,267,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,359.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,359.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,394.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,295.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,360.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,409.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,422.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,431.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,289.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,267,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,267,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,267,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,267,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,267,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,400.5,
PLATE LOCKING RROW 2.0-46MM,2001659,CDM,278,RC,,,outpatient,,,1125,562.5,,1091.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,675,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,337.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,1012.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,1012.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,675,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,818.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,767.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,675,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,908.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,908.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,996.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,745.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,911.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1035,92,,,percent of total billed charges,Pays at 92% of total billed charges,1068.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,1091.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,731.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,675,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,675,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,675,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1012.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,675,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,675,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1012.5,
SCREW locking T6 2.0MM L8MM,2001660,CDM,278,RC,,,outpatient,,,357.75,178.88,,347.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,321.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,321.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,260.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,244.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,288.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,288.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,317,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,237.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,289.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,329.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,339.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,347.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,232.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,321.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,321.98,
SCREW locking T6 2.0MM L10MM,2001661,CDM,278,RC,,,outpatient,,,357.75,178.88,,347.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,321.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,321.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,260.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,244.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,288.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,288.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,317,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,237.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,289.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,329.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,339.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,347.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,232.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,321.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,321.98,
SCREW locking T6 2.0MM L13MM,2001662,CDM,278,RC,,,outpatient,,,357.75,178.88,,347.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,321.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,321.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,260.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,244.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,288.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,288.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,317,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,237.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,289.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,329.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,339.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,347.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,232.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,321.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,321.98,
SCREW locking T6 2.0MM L14MM,2001663,CDM,278,RC,,,outpatient,,,357.75,178.88,,347.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,321.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,321.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,260.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,244.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,288.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,288.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,317,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,237.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,289.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,329.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,339.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,347.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,232.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,321.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,321.98,
SCREW locking T6 2.0MM L18MM,2001664,CDM,278,RC,,,outpatient,,,357.75,178.88,,347.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,321.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,321.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,260.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,244.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,288.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,288.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,317,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,237.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,289.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,329.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,339.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,347.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,232.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,321.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,214.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,321.98,
SCREW BONE T6 2.0M -L9MM,2001665,CDM,278,RC,,,outpatient,,,208.75,104.38,,202.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,125.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,187.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,142.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,125.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,168.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,184.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,138.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,169.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,192.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,198.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,202.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,125.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,125.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,187.88,
SCREW BONE T6 2.0M -L10MM,2001666,CDM,278,RC,,,outpatient,,,208.75,104.38,,202.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,125.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,187.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,142.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,125.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,168.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,184.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,138.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,169.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,192.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,198.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,202.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,125.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,125.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,187.88,
SCREW BONE T6 2.0M -L14MM,2001667,CDM,278,RC,,,outpatient,,,208.75,104.38,,202.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,125.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,187.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,142.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,125.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,168.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,184.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,138.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,169.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,192.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,198.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,202.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,125.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,125.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,187.88,
BLADE SCREW DRIOVER T6 AO,2001668,CDM,270,RC,,,outpatient,,,1529.85,764.93,,1483.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,917.91,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,458.96,30,,,percent of total billed charges,Pays at 30% of total billed charges,1376.87,90,,,percent of total billed charges,Pays at 90% of total billed charges,1376.87,90,,,percent of total billed charges,Pays at 90% of total billed charges,917.91,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1113.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1044.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,917.91,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1234.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1234.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1355.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1014.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1239.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1407.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,1453.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,1483.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,994.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,917.91,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,917.91,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,917.91,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1376.87,90,,,percent of total billed charges,Pays at 90% of total billed charges,917.91,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,917.91,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1376.87,
TIGHT ROPE SYNDESMOS XP TITANIAM,2001669,CDM,278,RC,,,outpatient,,,3458.5,1729.25,,3354.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,2075.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1037.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,3112.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,3112.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2075.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2516.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2360.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2075.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2791.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2791.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3064.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2292.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2801.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3181.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,3285.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,3354.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,2248.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,2075.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2075.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2075.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3112.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2075.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2075.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3112.65,
SCREW LO PRO TM SS 3.5,2001670,CDM,278,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
SCREW LO PRO TM SS 4.0,2001671,CDM,278,RC,,,outpatient,,,358.25,179.13,,347.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,214.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,322.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,322.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,214.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,260.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,244.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,214.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,289.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,289.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,317.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,237.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,290.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,329.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,340.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,347.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,232.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,214.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,214.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,214.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,322.43,
SCREW  CORT 3.5X55MM,2001672,CDM,278,RC,,,outpatient,,,152.25,76.13,,147.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,137.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,103.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,122.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,100.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,123.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,140.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,144.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,147.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,137.03,
SCREW  CORT 4X46MM,2001673,CDM,278,RC,,,outpatient,,,347.25,173.63,,336.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,208.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,312.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,312.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,208.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,237,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,208.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,280.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,280.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,307.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,230.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,281.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,319.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,329.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,336.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,225.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,208.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,312.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,208.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,208.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,312.53,
BONE CEMENT CONFLOW,2001674,CDM,270,RC,,,outpatient,,,139,69.5,,134.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,125.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,94.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,112.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,127.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,134.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,83.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,125.1,
CER  OPTION TYPE 1 TPR SLEVE+3,2001675,CDM,278,RC,,,outpatient,,,217,108.5,,210.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,130.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,195.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,195.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,148.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,130.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,175.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,175.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,192.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,143.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,175.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,199.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,206.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,210.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,141.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,130.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,130.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,195.3,
PSN ASF PS 10MM VE R 6-9 EF,2001676,CDM,278,RC,,,outpatient,,,2387,1193.5,,2315.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2148.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,2148.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1736.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1629.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1926.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1926.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2115.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1582.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1933.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2196.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,2267.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,2315.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,1551.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2148.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2148.3,
G7  HIGH WALL ARCOMXL 36MM F,2001678,CDM,278,RC,,,outpatient,,,1627.5,813.75,,1578.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,976.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1464.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,1464.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,976.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1184.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1110.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,976.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1313.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1313.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1442.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1079.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1318.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1497.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,1546.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,1578.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,1057.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,976.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,976.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,976.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1464.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,976.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,976.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1464.75,
G7  HIGH WALL ARCOMXL 36MM D,2001679,CDM,278,RC,,,outpatient,,,1627.5,813.75,,1578.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,976.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1464.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,1464.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,976.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1184.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1110.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,976.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1313.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1313.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1442.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1079.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1318.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1497.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,1546.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,1578.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,1057.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,976.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,976.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,976.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1464.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,976.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,976.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1464.75,
PSN TIN STM 5 DEGREE SZ ER,2001680,CDM,278,RC,,,outpatient,,,1909.25,954.63,,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1389.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1303.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1691.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1265.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1546.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1756.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,1813.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1241.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1718.33,
PSN TIB STM 5 PEG SZ G L,2001682,CDM,278,RC,,,outpatient,,,1909.25,954.63,,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1389.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1303.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1691.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1265.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1546.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1756.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,1813.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1241.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1718.33,
PSN ASF CR 10MM VE L 7-12GH,2001683,CDM,278,RC,,,outpatient,,,2387,1193.5,,2315.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2148.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,2148.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1736.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1629.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1926.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1926.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2115.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1582.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1933.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2196.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,2267.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,2315.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,1551.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2148.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2148.3,
LONG IL KIT R1/5 TI LT B11X300MMX25,2001686,CDM,278,RC,,,outpatient,,,4308.25,2154.13,,4179,97,,,percent of total billed charges,Pays at 97% of total billed charges,2584.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1292.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,3877.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,3877.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,2584.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3134.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2940.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2584.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3477.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3477.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3817.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2856.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3489.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3963.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,4092.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,4179,97,,,percent of total billed charges,Pays at 97% of total billed charges,2800.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,2584.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2584.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2584.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3877.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,2584.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2584.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3877.43,
WRIST FUSION PLATE STD  120MM,2001688,CDM,278,RC,,,outpatient,,,3334.5,1667.25,,3234.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,2000.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1000.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,3001.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,3001.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,2000.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2426.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2275.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2000.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2691.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2691.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2954.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2210.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2700.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3067.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,3167.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,3234.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,2167.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,2000.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2000.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2000.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3001.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,2000.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2000.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3001.05,
TRAY BONE MARROW /ASPIRATION,2001689,CDM,272,RC,,,outpatient,,,108.75,54.38,,105.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,97.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,74.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,72.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,88.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,100.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,103.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,105.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,97.88,
ENDO GIA STAPLER STANDARD,2002010,CDM,272,RC,,,outpatient,,,233,116.5,,226.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,209.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,139.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,188.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,214.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,221.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,139.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,139.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,209.7,
ENDO GIA STAPLER SHORT,2002011,CDM,272,RC,,,outpatient,,,218.5,109.25,,211.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,196.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.98,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,149.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,131.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,176.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,193.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,144.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,176.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,201.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,207.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,211.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,142.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,131.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,131.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,196.65,
RELOAD ARTICULATING  30 MM MED,2002012,CDM,272,RC,,,outpatient,,,348.75,174.38,,338.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,209.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,313.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,253.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,238.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,209.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,281.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,281.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,309.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,231.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,282.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,320.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,331.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,338.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,226.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,209.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,209.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,313.88,
GIA STAPLER ENDO 45MM,2002013,CDM,272,RC,,,outpatient,,,1092.75,546.38,,1059.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,655.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,327.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,983.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,983.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,655.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,795.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,745.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,655.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,882.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,882.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,968.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,724.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,885.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1005.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,1038.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,1059.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,710.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,655.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,655.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,655.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,983.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,655.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,655.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,983.48,
ENDO GIA RELOAD 45-3.5MM,2002014,CDM,272,RC,,,outpatient,,,399.25,199.63,,387.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,239.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,359.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,359.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,239.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,290.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,272.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,239.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,322.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,353.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,264.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,323.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,367.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,379.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,387.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,259.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,239.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,239.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,239.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,359.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,239.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,239.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,359.33,
ENDO GIA RELOAD 60-3.5MM,2002015,CDM,272,RC,,,outpatient,,,596.5,298.25,,578.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,357.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,536.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,536.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,357.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,434.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,407.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,357.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,481.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,481.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,528.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,395.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,483.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,548.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,566.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,578.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,387.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,357.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,357.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,357.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,536.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,357.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,357.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,536.85,
ENDO GIA RELOAD 45-2.5MM,2002016,CDM,272,RC,,,outpatient,,,346.75,173.38,,336.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,208.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,312.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,312.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,208.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,236.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,208.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,279.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,279.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,307.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,229.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,280.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,319.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,329.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,336.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,225.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,208.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,312.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,208.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,208.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,312.08,
ENDO GIA RELOAD 60-2.5MM,2002018,CDM,272,RC,,,outpatient,,,505.5,252.75,,490.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,303.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,454.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,454.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,303.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,367.8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,345,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,303.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,408.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,408.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,447.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,335.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,409.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,465.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,480.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,490.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,328.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,303.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,303.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,303.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,454.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,303.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,303.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,454.95,
REINFORCED RELOAD 60AMT,2002019,CDM,272,RC,,,outpatient,,,1050.25,525.13,,1018.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,630.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,315.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,945.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,945.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,630.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,764.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,716.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,630.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,847.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,847.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,930.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,696.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,850.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,966.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,997.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,1018.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,682.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,630.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,630.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,630.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,945.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,630.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,630.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,945.23,
REINFORCED RELOAD 45- AMT,2002020,CDM,272,RC,,,outpatient,,,789.75,394.88,,766.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,473.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,236.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,710.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,710.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,473.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,574.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,539,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,473.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,637.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,637.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,699.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,523.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,639.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,726.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,750.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,766.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,513.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,473.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,473.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,473.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,710.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,473.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,473.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,710.78,
SAGITAL SAW BLADE,2002021,CDM,272,RC,,,outpatient,,,238.5,119.25,,231.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,143.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,214.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,214.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,143.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,162.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,143.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,192.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,211.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,158.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,193.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,219.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,226.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,231.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,143.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,143.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,143.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,214.65,
EXT PUMP TUBING  ER,2002022,CDM,272,RC,,,outpatient,,,6.25,3.13,,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,90,
DUET 60MM PURPLE,2002025,CDM,272,RC,,,outpatient,,,1548.25,774.13,,1501.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,928.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,464.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,1393.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,1393.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,928.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1126.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1056.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,928.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1249.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1249.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1371.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1026.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1254.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1424.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,1470.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,1501.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,1006.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,928.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,928.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,928.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1393.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,928.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,928.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1393.43,
DUET RELOAD 60- GREEN,2002026,CDM,272,RC,,,outpatient,,,1225.25,612.63,,1188.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,735.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,367.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,1102.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1102.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,735.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,891.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,836.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,735.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,989.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,989.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1085.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,812.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,992.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1127.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,1163.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,1188.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,796.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,735.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,735.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,735.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1102.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,735.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,735.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1102.73,
EGIA 45 AR VSCLRMD SUL,2002027,CDM,272,RC,,,outpatient,,,384.5,192.25,,372.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,230.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,346.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,346.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,230.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,279.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,262.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,230.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,310.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,310.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,340.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,254.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,311.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,353.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,365.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,372.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,249.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,230.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,230.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,230.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,346.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,230.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,230.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,346.05,
EGIA 60 AR VSCLRMD SUL,2002028,CDM,272,RC,,,outpatient,,,502.75,251.38,,487.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,301.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,452.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,452.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,301.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,365.8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,343.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,301.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,405.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,405.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,445.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,333.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,407.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,462.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,477.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,487.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,326.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,301.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,301.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,301.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,301.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,301.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,452.48,
EGIA 45 AR MED THKSUL,2002029,CDM,272,RC,,,outpatient,,,459.75,229.88,,445.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,275.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,413.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,413.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,275.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,334.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,313.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,275.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,371.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,371.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,407.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,304.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,372.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,422.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,436.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,445.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,298.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,275.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,275.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,275.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,413.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,275.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,275.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,413.78,
EGIA 60 AR MED THKSUL,2002030,CDM,272,RC,,,outpatient,,,525.5,262.75,,509.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,315.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,472.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,472.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,315.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,382.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,358.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,315.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,424.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,424.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,465.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,348.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,425.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,483.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,499.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,509.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,341.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,315.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,315.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,315.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,472.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,315.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,315.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,472.95,
ENDO CLIP III 5MM CLIP APPLIER,2002031,CDM,272,RC,,,outpatient,,,320.5,160.25,,310.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,192.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,288.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,288.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,192.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,233.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,218.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,192.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,258.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,258.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,284,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,212.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,259.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,294.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,304.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,310.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,208.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,192.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,288.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,192.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,192.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,288.45,
DRESSING CHANGE KIT,2002033,CDM,272,RC,,,outpatient,,,52.25,26.13,,50.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,35.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,49.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,50.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.35,90,
ENDO STITCH 10MM,2002034,CDM,272,RC,,,outpatient,,,258.75,129.38,,250.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,232.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.27,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,176.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,155.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,229.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,171.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,209.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,238.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,245.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,250.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,155.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,155.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,232.88,
SURGIDAC O,2002035,CDM,272,RC,,,outpatient,,,150.25,75.13,,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135.23,
SURGIDAC 2.0,2002036,CDM,272,RC,,,outpatient,,,150.25,75.13,,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135.23,
POLYSORB 2.0,2002037,CDM,272,RC,,,outpatient,,,94.25,47.13,,91.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,84.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,64.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,62.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,76.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,86.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,89.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,91.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.55,90,
VERSASTEP 5MM TROCAR,2002038,CDM,272,RC,,,outpatient,,,186.5,93.25,,180.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,167.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,167.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,127.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,111.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,165.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,123.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,151.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,171.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,177.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,180.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,111.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,111.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,167.85,
VERSASTEP LONG 5MM TROCAR,2002039,CDM,272,RC,,,outpatient,,,186.5,93.25,,180.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,167.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,167.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,127.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,111.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,165.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,123.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,151.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,171.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,177.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,180.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,111.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,111.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,167.85,
VERSASTEP 12MMTROCAR,2002040,CDM,272,RC,,,outpatient,,,119.75,59.88,,116.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,107.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,81.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,113.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,107.78,
VERSASTEP 15MMTROCAR,2002041,CDM,272,RC,,,outpatient,,,150.25,75.13,,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135.23,
INSUFFLATION NEEDLE STANDARD,2002042,CDM,272,RC,,,outpatient,,,69.5,34.75,,67.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,56.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,63.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,67.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,90,
INSUFFLATION NEEDLE LONG,2002043,CDM,272,RC,,,outpatient,,,70.5,35.25,,68.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,63.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,57.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,64.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,68.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.3,90,
ENDO CATCH 10MM,2002044,CDM,272,RC,,,outpatient,,,139.5,69.75,,135.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,113,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,128.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,135.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,125.55,
ENDO CATCH II 15MM,2002045,CDM,272,RC,,,outpatient,,,661.5,330.75,,641.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,396.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,595.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,595.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,396.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,481.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,451.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,396.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,533.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,533.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,586.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,438.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,535.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,608.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,628.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,641.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,429.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,396.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,396.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,396.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,595.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,396.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,396.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,595.35,
ROTICULATOR ENDO DISSECT,2002046,CDM,272,RC,,,outpatient,,,207,103.5,,200.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,186.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,186.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,124.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.61,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,141.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,124.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,167.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,183.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,137.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,167.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,190.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,196.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,200.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,134.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,124.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,124.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,124.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,186.3,
ROTICULATOR ENDO MINI SHEARS,2002047,CDM,272,RC,,,outpatient,,,239,119.5,,231.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,143.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,215.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,215.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,143.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,163.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,143.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,192.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,211.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,158.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,193.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,219.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,227.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,231.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,143.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,143.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,143.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,215.1,
ROTICULATOR ENDOGRASP,2002048,CDM,272,RC,,,outpatient,,,207,103.5,,200.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,186.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,186.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,124.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.61,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,141.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,124.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,167.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,183.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,137.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,167.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,190.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,196.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,200.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,134.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,124.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,124.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,124.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,186.3,
ENDO CLOSE,2002049,CDM,272,RC,,,outpatient,,,112.75,56.38,,109.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,101.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,103.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,107.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,109.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,67.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,101.48,
PULSE OX NEOTAL PROBES,2002050,CDM,271,RC,,,outpatient,,,46,23,,44.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,37.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,42.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,90,
PULSE OX ADULT PROBES,2002051,CDM,271,RC,,,outpatient,,,39.5,19.75,,38.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,36.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,37.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,38.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.7,90,
MASK FACE NEO,2002055,CDM,272,RC,,,outpatient,,,14,7,,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,90,
MASK FACE INFANT,2002056,CDM,272,RC,,,outpatient,,,14,7,,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,90,
MASK FACE SMALL ADULT,2002057,CDM,272,RC,,,outpatient,,,9.5,4.75,,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,90,
A,2002058,CDM,272,RC,,,outpatient,,,8,4,,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,90,
MASK FACE MED ADULT,2002060,CDM,272,RC,,,outpatient,,,14,7,,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,90,
MASK FACE LG ADULT,2002061,CDM,272,RC,,,outpatient,,,14,7,,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,90,
ENDO PADDLE RETRACT 12 MM,2002062,CDM,272,RC,,,outpatient,,,251.75,125.88,,244.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,226.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,226.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,151.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,171.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,151.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,203.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,223.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,166.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,203.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,231.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,239.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,244.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,163.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,151.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,151.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,151.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,226.58,
EEA 21MM 3.5 STAPLES,2002063,CDM,272,RC,,,outpatient,,,2325,1162.5,,2255.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,1395,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,697.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,2092.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,2092.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,1395,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1691.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1586.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1395,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1876.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1876.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2060.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1541.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1883.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2139,92,,,percent of total billed charges,Pays at 92% of total billed charges,2208.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,2255.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,1511.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,1395,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1395,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1395,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2092.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,1395,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1395,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2092.5,
EEA 25MM 3.5 STAPLES,2002064,CDM,272,RC,,,outpatient,,,2325,1162.5,,2255.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,1395,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,697.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,2092.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,2092.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,1395,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1691.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1586.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1395,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1876.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1876.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2060.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1541.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1883.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2139,92,,,percent of total billed charges,Pays at 92% of total billed charges,2208.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,2255.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,1511.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,1395,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1395,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1395,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2092.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,1395,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1395,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2092.5,
EEA 28MM4.8MM STAPLES,2002065,CDM,272,RC,,,outpatient,,,2251.25,1125.63,,2183.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,1350.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,675.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,2026.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,2026.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,1350.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1638.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1536.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1350.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1817.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1817.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1994.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1492.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1823.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2071.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,2138.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,2183.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,1463.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,1350.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1350.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1350.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2026.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,1350.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1350.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2026.13,
METANEB CIRCUIT,2002066,CDM,271,RC,,,outpatient,,,240.5,120.25,,233.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,144.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,216.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,216.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,144.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,164.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,144.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,194.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,213.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,159.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,194.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,221.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,228.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,233.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,156.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,144.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,216.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,144.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,144.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,216.45,
EEA 31MM4.8MM STAPLES,2002067,CDM,272,RC,,,outpatient,,,805.25,402.63,,781.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,483.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,241.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,724.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,724.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,483.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,585.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,549.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,483.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,650,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,650,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,713.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,533.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,652.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,740.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,764.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,781.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,523.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,483.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,483.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,483.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,724.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,483.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,483.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,724.73,
EEA 33MM4.8MM STAPLES,2002068,CDM,272,RC,,,outpatient,,,2012.5,1006.25,,1952.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,1207.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,603.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,1811.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1811.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1207.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1464.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1373.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1207.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1624.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1624.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1783.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1334.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1630.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1851.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,1911.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,1952.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,1308.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,1207.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1207.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1207.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1811.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1207.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1207.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1811.25,
EEA SIZERS,2002069,CDM,272,RC,,,outpatient,,,1065.25,532.63,,1033.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,639.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,319.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,958.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,958.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,639.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,775.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,727.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,639.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,859.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,859.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,943.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,706.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,862.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,980.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1011.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,1033.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,692.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,639.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,639.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,639.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,958.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,639.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,639.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,958.73,
MAMMOSITE RADIATION DELIVERY SYSTEM,2002071,CDM,278,RC,,,outpatient,,,7160.75,3580.38,,6945.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,4296.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,6444.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,6444.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,4296.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5210.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4887.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4296.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5780.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5780.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6345.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4747.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5800.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6587.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,6802.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,6945.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,4654.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,4296.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4296.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4296.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6444.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,4296.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4296.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,6444.68,
VENTILATOR CIRCUITS,2002074,CDM,271,RC,,,outpatient,,,122.25,61.13,,118.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,110.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,99.02,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,118.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,110.03,
ENDO PEANUT,2002075,CDM,272,RC,,,outpatient,,,34.5,17.25,,33.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,31.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,32.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.7,90,
PT TENS UNIT,2002076,CDM,290,RC,,,outpatient,,,104.75,52.38,,101.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.09,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,94.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,71.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,69.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,84.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,96.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,99.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,101.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,62.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,62.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,62.85,
HARMONIC 45CM,2002077,CDM,272,RC,,,outpatient,,,2555.25,1277.63,,2478.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,1533.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,766.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,2299.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,2299.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1533.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1859.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1743.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1533.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2062.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2062.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2264.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1694.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2069.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2350.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,2427.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,2478.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,1660.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,1533.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1533.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1533.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2299.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1533.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1533.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2299.73,
ENDO GIA stapler XL,2002078,CDM,272,RC,,,outpatient,,,388.5,194.25,,376.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,233.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,349.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,349.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,233.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,282.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,265.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,233.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,313.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,344.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,257.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,314.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,357.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,369.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,376.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,252.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,233.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,233.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,233.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,349.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,233.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,233.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,349.65,
TRI STAPLER 45MM CURVED TIP,2002079,CDM,272,RC,,,outpatient,,,1113,556.5,,1079.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,667.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,333.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,1001.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1001.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,667.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,809.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,759.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,667.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,898.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,898.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,986.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,737.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,901.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1023.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,1057.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,1079.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,723.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,667.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,667.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,667.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1001.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,667.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,667.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1001.7,
PURSE STRING 45MM,2002080,CDM,272,RC,,,outpatient,,,177.5,88.75,,172.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,159.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,121.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,106.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,157.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,117.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,143.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,163.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,168.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,172.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,115.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,106.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,159.75,
PURSE STRING65MM,2002081,CDM,272,RC,,,outpatient,,,194.25,97.13,,188.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,174.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,132.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,172.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,128.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,157.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,178.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,184.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,188.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,126.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,174.83,
ENDO GIA 45 MM EX THICK RELOAD,2002082,CDM,272,RC,,,outpatient,,,568.75,284.38,,551.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,341.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,511.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,511.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,341.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,413.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,388.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,341.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,459.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,459.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,503.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,377.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,460.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,523.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,540.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,551.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,369.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,341.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,341.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,341.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,511.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,341.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,341.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,511.88,
ENDO GIA60 MM  EX THICK RELOAD,2002083,CDM,272,RC,,,outpatient,,,684.5,342.25,,663.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,616.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,616.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,498.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,467.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,552.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,552.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,606.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,453.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,554.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,629.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,650.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,663.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,444.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,616.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,616.05,
12 MM LONG VERSASTEP,2002084,CDM,272,RC,,,outpatient,,,115.25,57.63,,111.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.73,
OXYKID AEROSOL KIT,2002085,CDM,270,RC,,,outpatient,,,21.75,10.88,,21.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,21.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,90,
OXYTYKE AEROSOL KIT,2002086,CDM,270,RC,,,outpatient,,,21.75,10.88,,21.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,21.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,90,
C PAP SAL MASK M (BARIATRIC),2002087,CDM,272,RC,,,outpatient,,,236.25,118.13,,229.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,141.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,212.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,212.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,161.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,141.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,190.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,209.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,156.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,191.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,217.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,224.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,229.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,153.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,141.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,141.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,212.63,
GRASPERS 5MM,2002088,CDM,272,RC,,,outpatient,,,761,380.5,,738.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,456.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,684.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,684.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,456.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,553.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,519.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,456.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,614.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,614.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,674.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,504.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,616.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,700.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,722.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,738.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,494.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,456.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,456.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,456.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,684.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,456.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,456.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,684.9,
GRASPER  SILSCLINCH,2002089,CDM,272,RC,,,outpatient,,,761,380.5,,738.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,456.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,684.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,684.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,456.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,553.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,519.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,456.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,614.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,614.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,674.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,504.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,616.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,700.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,722.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,738.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,494.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,456.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,456.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,456.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,684.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,456.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,456.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,684.9,
V-60 VENTILATOR CIRCUITS,2002090,CDM,271,RC,,,outpatient,,,29,14.5,,28.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.4,90,
LASER KIT 65.CM,2002091,CDM,272,RC,,,outpatient,,,857.25,428.63,,831.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,514.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,257.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,771.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,771.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,514.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,623.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,585.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,514.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,691.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,691.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,759.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,568.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,694.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,788.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,814.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,831.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,557.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,514.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,514.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,514.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,771.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,514.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,514.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,771.53,
FLEXI SEAL FMS,2002092,CDM,272,RC,,,outpatient,,,477,238.5,,462.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,286.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,429.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,429.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,286.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,347.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,325.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,286.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,385.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,385.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,422.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,316.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,386.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,438.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,453.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,462.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,310.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,286.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,286.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,286.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,429.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,286.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,286.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,429.3,
STAPLER TA ROTIC 55 W/ 3.5,2002093,CDM,272,RC,,,outpatient,,,1701,850.5,,1649.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1020.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,510.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,1530.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,1530.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,1020.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1237.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1160.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1020.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1373.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1373.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1507.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1127.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1377.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1564.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,1615.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,1649.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1105.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,1020.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1020.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1020.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1530.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,1020.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1020.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1530.9,
STAPLER TA ROTIC 55 W/ 4.8 STAPLES,2002094,CDM,272,RC,,,outpatient,,,200.75,100.38,,194.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,180.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,180.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,137.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,177.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,133.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,162.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,184.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,190.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,194.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,130.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,180.68,
VENTILATOR CIRCUIT AIRLIFE SMOOTH,2002095,CDM,271,RC,,,outpatient,,,38.5,19.25,,37.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,34.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,23.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,31.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,35.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,36.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,23.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.1,90,
PULSE OX PEDS PROBES,2002096,CDM,271,RC,,,outpatient,,,36.25,18.13,,35.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,32.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,33.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.75,90,
PAK LASER VEIN,2002097,CDM,278,RC,,,outpatient,,,162,81,,157.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,861.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,145.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,145.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,153.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,97.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,145.8,
VENTILATOR CIRCUITS AIRLIFE,2002098,CDM,271,RC,,,outpatient,,,24.5,12.25,,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,90,
BUTTON REPLACMENT GASTRO DEVICE,2002099,CDM,272,RC,,,outpatient,,,683.25,341.63,,662.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,409.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,204.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,614.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,614.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,409.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,497.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,466.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,409.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,551.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,551.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,605.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,452.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,553.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,628.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,649.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,662.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,444.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,409.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,409.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,409.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,614.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,409.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,409.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,614.93,
INTRODUCER  DEVICE 21MM,2002100,CDM,272,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
ADULT SP O2 DISPOSABLE EAR SENSOR,2002101,CDM,271,RC,,,outpatient,,,60.5,30.25,,58.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,54.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,41.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,36.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,53.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,40.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,49.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,55.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,57.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,58.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,36.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,36.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.3,90,
DUET RELOAD 60AXT/BLACKS,2002102,CDM,272,RC,,,outpatient,,,1104.5,552.25,,1071.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,662.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,331.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,994.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,994.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,662.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,803.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,753.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,662.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,891.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,891.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,978.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,732.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,894.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1016.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,1049.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,1071.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,717.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,662.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,662.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,662.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,994.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,662.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,662.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,994.05,
RESQPOD ITD 10,2002103,CDM,272,RC,,,outpatient,,,234,117,,226.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,207.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,155.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,215.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,222.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,152.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.6,
TRI STAPLER 30M TANVAS/MED RELOAD,2002104,CDM,272,RC,,,outpatient,,,416.25,208.13,,403.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,249.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,374.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,374.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,249.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,302.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,284.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,249.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,336,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,336,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,368.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,275.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,337.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,382.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,395.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,403.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,270.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,249.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,249.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,249.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,374.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,249.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,249.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,374.63,
REINFORCED BLACK RELOAD 45- AXT,2002105,CDM,272,RC,,,outpatient,,,875.25,437.63,,848.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,525.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,787.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,787.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,525.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,636.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,597.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,525.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,706.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,706.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,775.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,580.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,708.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,805.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,831.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,848.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,568.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,525.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,525.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,525.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,787.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,525.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,525.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,787.73,
STAPLER 60 green 4.8mm,2002106,CDM,272,RC,,,outpatient,,,249,124.5,,241.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,149.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,224.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,169.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,149.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,220.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,165.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,201.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,229.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,236.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,241.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,161.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,149.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,149.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,224.1,
STAPLER 80 BLUE 3.8mm,2002107,CDM,272,RC,,,outpatient,,,184.5,92.25,,178.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,110.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,166.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,125.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,110.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,163.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,122.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,149.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,169.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,175.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,178.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,119.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,110.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,110.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,166.05,
STAPLER 80 GREEN4.8mm,2002109,CDM,272,RC,,,outpatient,,,184,92,,178.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,110.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,165.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,125.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,110.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,163.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,149.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,169.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,174.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,178.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,119.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,110.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,110.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,165.6,
HM C2/C3 CIRCUIT W/EXPAND VAULE,2002110,CDM,271,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.45,
AUTOCLAVABLE PC,2002111,CDM,271,RC,,,outpatient,,,93.5,46.75,,90.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,84.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,75.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,86.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,88.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,90.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,90,
ENDO GIA STAPLER 8048.L,2002112,CDM,272,RC,,,outpatient,,,194.5,97.25,,188.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,116.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,175.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,175.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,116.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,132.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,116.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,157,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,172.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,128.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,157.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,178.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,184.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,188.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,126.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,116.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,175.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,116.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,116.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,175.05,
ENDO GIA STAPLER 8038.S,2002113,CDM,272,RC,,,outpatient,,,373,186.5,,361.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,223.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,335.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,335.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,223.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,254.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,223.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,301.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,301.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,330.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,247.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,302.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,343.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,354.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,361.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,242.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,223.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,335.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,223.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,223.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,335.7,
TWISTER PLUS,2002114,CDM,278,RC,,,outpatient,,,1289.75,644.88,,1251.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,773.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.78,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1160.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,1160.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,773.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,938.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,880.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,773.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1041.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1041.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1142.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,855.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1044.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1186.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,1225.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,1251.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,838.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,773.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,773.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,773.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1160.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,773.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,773.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1160.78,
ENDOSCOPIC MARKER SPOT,2002115,CDM,272,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
PLEURX DRAIN KIT 1000 ML VAC BOTTLE,2002116,CDM,272,RC,,,outpatient,,,195.5,97.75,,189.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,175.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,175.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,133.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,117.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,157.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,173.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,129.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,158.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,179.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,185.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,189.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,127.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,117.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,175.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,117.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,175.95,
EAR SENSOR PROBES,2002117,CDM,271,RC,,,outpatient,,,101.5,50.75,,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,82.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,93.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,91.35,
SERVO HUMIDIFICATION CHAMBER,2002121,CDM,271,RC,,,outpatient,,,53.25,26.63,,51.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,47.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,43.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.95,90,
PULSE OX ADULT sensors,2002125,CDM,271,RC,,,outpatient,,,72.5,36.25,,70.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,65.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,49.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,43.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,48.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,58.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,66.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,68.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,70.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,43.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,43.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.5,90,
C PAP SAL MASK  L (BARIATRIC),2002126,CDM,272,RC,,,outpatient,,,236.25,118.13,,229.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,141.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,212.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,212.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,161.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,141.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,190.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,209.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,156.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,191.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,217.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,224.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,229.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,153.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,141.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,141.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,212.63,
STAPLER ENDO 28MM SINGLE USE 22CM,2002127,CDM,272,RC,,,outpatient,,,748.75,374.38,,726.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,449.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,673.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,673.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,449.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,544.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,511.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,449.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,604.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,604.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,663.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,496.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,606.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,688.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,711.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,726.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,486.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,449.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,449.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,449.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,673.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,449.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,449.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,673.88,
ENDO 10MM CLIP APPLIER,2002136,CDM,272,RC,,,outpatient,,,213.25,106.63,,206.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,127.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,191.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,191.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,145.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,127.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,172.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,141.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,172.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,196.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,202.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,206.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,138.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,127.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,191.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,127.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,191.93,
PULSE OX INF PROBES,2002137,CDM,271,RC,,,outpatient,,,36.25,18.13,,35.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,32.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,33.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.75,90,
CANNULA ENDOMETRIAL,2002138,CDM,272,RC,,,outpatient,,,36.75,18.38,,35.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,33.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,33.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,90,
STEEL CABLE,2002155,CDM,272,RC,,,outpatient,,,703.75,351.88,,682.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,422.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,211.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,633.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,633.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,422.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,512.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,480.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,422.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,568.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,568.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,623.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,466.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,570.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,647.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,668.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,682.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,457.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,422.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,422.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,422.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,633.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,422.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,422.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,633.38,
LARYNGOSCOPE BLADE CHANNELED,2002156,CDM,272,RC,,,outpatient,,,157.25,78.63,,152.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.53,
LARYNGOSCOPE BLADESTANDARD,2002157,CDM,272,RC,,,outpatient,,,157.25,78.63,,152.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.53,
ROTICULATOR SILSCLINCH,2002158,CDM,272,RC,,,outpatient,,,460.5,230.25,,446.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,414.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,414.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,335.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,314.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,371.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,371.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,408.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,305.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,373.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,423.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,437.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,446.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,299.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,414.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,414.45,
ROTICULATOR,2002159,CDM,272,RC,,,outpatient,,,234,117,,226.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,207.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,155.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,215.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,222.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,152.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.6,
DRESSING  AQUACELL EXTRA  AG 4X6,2002160,CDM,272,RC,,,outpatient,,,114.75,57.38,,111.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,103.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,68.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,92.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,105.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,68.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,68.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.28,
DRESSING  AQUACELL EXTRA  AG 6X6,2002161,CDM,272,RC,,,outpatient,,,128.25,64.13,,124.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,115.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,87.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,76.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,85.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,103.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,117.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,121.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,124.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,76.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,76.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,115.43,
HIGH COMPRESSION BANDAGE,2002162,CDM,272,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,90,
ALOE VESTA BARRIOR SPRAY,2002164,CDM,272,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,90,
SENSI CARE CLEAR ZINC,2002165,CDM,272,RC,,,outpatient,,,7,3.5,,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,90,
BARRIER SPRAY PROTECTIVE,2002166,CDM,272,RC,,,outpatient,,,14.5,7.25,,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,90,
STING FREE ADHESIVE,2002167,CDM,272,RC,,,outpatient,,,58.25,29.13,,56.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,52.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,47.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,53.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,55.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,56.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.95,90,
BI/LEVEL HEATED  CIRCUIT,2002168,CDM,271,RC,,,outpatient,,,166.5,83.25,,161.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,149.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,99.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,134.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,161.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,99.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,99.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,149.85,
IODASORB,2002169,CDM,272,RC,,,outpatient,,,72,36,,69.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,64.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,49.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,43.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,58.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,66.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,68.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,43.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,43.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.2,90,
RING BARRIER4.5MM,2002170,CDM,272,RC,,,outpatient,,,11.5,5.75,,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,90,
DRESSING ISLAND SILVERLON 4X6,2002171,CDM,272,RC,,,outpatient,,,87.25,43.63,,84.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,78.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,57.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,70.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,82.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,84.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,52.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.35,90,
DRESSING ISLAND SILVERLON 4X10,2002172,CDM,272,RC,,,outpatient,,,174,87,,168.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,156.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,156.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,118.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,104.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,140.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,115.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,140.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,160.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,165.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,168.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,104.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,156.6,
DRESSING PAD SILVERLON 4X4.5,2002173,CDM,272,RC,,,outpatient,,,90.25,45.13,,87.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,73.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,83.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,85.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,87.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,90,
DRESSING ISLAND SILVERLON 4X4,2002174,CDM,272,RC,,,outpatient,,,72.5,36.25,,70.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,65.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,49.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,43.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,48.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,58.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,66.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,68.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,70.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,43.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,43.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.5,90,
DRESSINGFIBER GELLING 6X6,2002175,CDM,272,RC,,,outpatient,,,28.75,14.38,,27.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,90,
DRESSING ABSORBANT SUPER 5X6,2002176,CDM,272,RC,,,outpatient,,,14.5,7.25,,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,90,
DRESSING ABSORBANT SUPER4X9,2002177,CDM,272,RC,,,outpatient,,,19.25,9.63,,18.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,17.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.55,90,
DRESSING GENTLE BORDER 4X4,2002178,CDM,272,RC,,,outpatient,,,13,6.5,,12.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,90,
GAMMA 3 IL RT/10X420MMX125,2002723,CDM,270,RC,,,outpatient,,,1028.75,514.38,,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,748.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,702.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,911.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,682.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,833.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,946.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,977.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,668.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,925.88,
CODEPAK RESUCITOR,2003012,CDM,272,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
6%GEN 75/.9 SOD CHL,2003103,CDM,258,RC,,,outpatient,,,173.75,86.88,,168.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,156.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,156.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,118.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,104.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,140.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,153.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,115.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,140.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,159.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,165.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,168.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,104.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,156.38,
QUIK-PACE ELECTRODE,2003108,CDM,271,RC,,,outpatient,,,86.25,43.13,,83.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,57.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,79.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.75,90,
QUIK-PACE DEFIB -ER,2003109,CDM,271,RC,,,outpatient,,,71.25,35.63,,69.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,64.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,57.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,65.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,67.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.75,90,
A.E.D.PADS ADULT,2003110,CDM,271,RC,,,outpatient,,,264.75,132.38,,256.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,158.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,238.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,238.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,158.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,180.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,158.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,213.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,234.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,175.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,214.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,243.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,251.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,256.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,172.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,158.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,158.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,158.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,238.28,
A.E.D.PADS PEDS,2003111,CDM,271,RC,,,outpatient,,,158.25,79.13,,153.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,142.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,108.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,140.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,128.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,145.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,150.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,153.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,142.43,
QUIK-,2003112,CDM,271,RC,,,outpatient,,,94.75,47.38,,91.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,85.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,64.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,56.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,62.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,76.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,87.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,90.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,91.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,56.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.85,90,
QUIK-PACE PED ELECTRODE,2003147,CDM,271,RC,,,outpatient,,,94.25,47.13,,91.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,84.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,64.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,62.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,76.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,86.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,89.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,91.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.55,90,
BAG DRAIGE,2003148,CDM,271,RC,,,outpatient,,,16.25,8.13,,15.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,90,
BAG DRAIGE 4000ML,2003149,CDM,271,RC,,,outpatient,,,20.25,10.13,,19.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,18.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.15,90,
URINE METER/WITH BAG,2003150,CDM,271,RC,,,outpatient,,,30.75,15.38,,29.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,27.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.45,90,
PLEUR-VAC/STAND,2003152,CDM,272,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
TRAY URETHRAL CATH 16/FR,2003154,CDM,272,RC,,,outpatient,,,6.75,3.38,,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,90,
CATH TRY 14 FR,2003155,CDM,272,RC,,,outpatient,,,13.25,6.63,,12.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.95,90,
CATH-FOLEY TRAY 16FR,2003156,CDM,272,RC,,,outpatient,,,27,13.5,,26.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,24.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.2,90,
CATH-FOLEY TRAY 18FR,2003158,CDM,272,RC,,,outpatient,,,31,15.5,,30.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,90,
SLING XLG DISP,2003159,CDM,271,RC,,,outpatient,,,228,114,,221.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,136.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,205.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,205.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,155.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,136.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,184.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,202.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,151.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,184.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,209.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,216.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,221.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,148.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,136.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,136.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,205.2,
TOE IMPLANT A,2003161,CDM,278,RC,,,outpatient,,,2789.25,1394.63,,2705.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,1673.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,836.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,2510.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,2510.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1673.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2029.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1903.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1673.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2251.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2251.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2471.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1849.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2259.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2566.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,2649.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,2705.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,1813.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,1673.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1673.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1673.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2510.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1673.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1673.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2510.33,
SPIL ANESTH 4773-1,2003162,CDM,272,RC,,,outpatient,,,98,49,,95.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,88.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,66.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,58.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,64.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,79.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,90.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,93.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,95.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,58.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,58.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.8,90,
SLING (DR.HOLEHOUSE),2003164,CDM,271,RC,,,outpatient,,,5213.5,2606.75,,5057.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,3128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1564.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,4692.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4692.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,3128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3793.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3558.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4208.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4208.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4619.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3456.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4222.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4796.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,4952.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,5057.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,3388.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,3128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4692.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,3128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4692.15,
THORACENTESIS TRAY,2003165,CDM,272,RC,,,outpatient,,,127.75,63.88,,123.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,114.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,87.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,76.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,84.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,103.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,117.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,121.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,123.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,76.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,76.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,114.98,
TRI-FLO BREATH EXER,2003166,CDM,272,RC,,,outpatient,,,8.75,4.38,,8.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,90,
LUMBAR PUNCTURE/ADU,2003168,CDM,272,RC,,,outpatient,,,75.5,37.75,,73.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,69.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,73.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,90,
LUMBAR PUNCTURE CHILD,2003169,CDM,270,RC,,,outpatient,,,67,33.5,,64.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,60.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,45.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,40.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,59.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,44.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,54.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,61.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,63.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,64.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,40.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.2,90,
PERITONEAL LAV KIT,2003170,CDM,272,RC,,,outpatient,,,115.5,57.75,,112.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,103.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.95,
SLING UPHOLD LITE,2003171,CDM,271,RC,,,outpatient,,,6027.25,3013.63,,5846.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,3616.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1808.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,5424.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,5424.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,3616.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4385.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4113.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3616.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4865.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4865.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5340.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3996.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4882.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5545.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,5725.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,5846.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,3917.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,3616.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3616.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3616.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5424.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,3616.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3616.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,5424.53,
EPIDURAL KIT,2003172,CDM,272,RC,,,outpatient,,,80,40,,77.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24,30,,,percent of total billed charges,Pays at 30% of total billed charges,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,76,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52,65,,,percent of total billed charges,Pays at 65% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,90,
EPIDURAL /SPIL TRAY COMBINED,2003174,CDM,272,RC,,,outpatient,,,90,45,,87.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27,30,,,percent of total billed charges,Pays at 30% of total billed charges,81,90,,,percent of total billed charges,Pays at 90% of total billed charges,81,90,,,percent of total billed charges,Pays at 90% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,72.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,82.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,85.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,87.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,Pays at 90% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54,90,
HICKMAN CATH REP KIT,2003182,CDM,272,RC,,,outpatient,,,169.75,84.88,,164.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,115.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,137.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,112.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,137.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,156.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,161.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,164.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,110.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,152.78,
TRAY SPIL 22 GA,2003183,CDM,272,RC,,,outpatient,,,62,31,,60.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,42.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,50.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,57.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,58.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,60.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.2,90,
PERCU SHEATH INTRO KIT,2003185,CDM,272,RC,,,outpatient,,,178.25,89.13,,172.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,160.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,160.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,121.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,106.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,157.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,118.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,144.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,163.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,169.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,172.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,115.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,106.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,160.43,
CVP MONITOR,2003186,CDM,272,RC,,,outpatient,,,182,91,,176.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,124.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,109.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,161.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,147.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,167.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,176.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,109.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,109.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.8,
ENDO PATH 12MM BLUNT,2003187,CDM,272,RC,,,outpatient,,,596.25,298.13,,578.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,357.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,536.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,536.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,357.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,433.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,406.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,357.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,481.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,481.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,528.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,395.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,482.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,548.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,566.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,578.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,387.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,357.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,357.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,357.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,536.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,357.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,357.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,536.63,
P E G KIT SYSTEM,2003192,CDM,272,RC,,,outpatient,,,188.25,94.13,,182.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,169.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,169.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,128.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,112.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,151.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,166.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,124.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,152.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,173.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,178.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,182.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,122.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,112.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,112.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,169.43,
DURA PREP,2003195,CDM,272,RC,,,outpatient,,,19.75,9.88,,19.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,17.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,18.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.85,90,
CHLORAPREP teal tent,2003197,CDM,272,RC,,,outpatient,,,28.25,14.13,,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,90,
CATH KIT 97-K140H-5F,2003198,CDM,272,RC,,,outpatient,,,223.25,111.63,,216.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,133.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,200.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,152.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,133.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,180.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,197.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,148.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,180.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,205.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,212.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,216.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,145.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,133.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,133.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,200.93,
CHLORAPREP teal tent 10.5ML,2003199,CDM,272,RC,,,outpatient,,,24.5,12.25,,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,90,
CHLORAPREP 26ML ORANGE,2003201,CDM,272,RC,,,outpatient,,,26.5,13.25,,25.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,23.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,90,
CATH KIT 3 LUMEN,2003202,CDM,272,RC,,,outpatient,,,258.25,129.13,,250.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,232.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,176.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,228.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,171.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,209.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,237.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,245.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,250.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,167.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,232.43,
STOPCOCK 3 WAY,2003210,CDM,272,RC,,,outpatient,,,3.75,1.88,,3.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,90,
STOPCOCK 3 WAY  MARTINEZ,2003211,CDM,272,RC,,,outpatient,,,9.25,4.63,,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,90,
STOP COCK 4 WAY,2003214,CDM,272,RC,,,outpatient,,,17,8.5,,16.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,90,
STOP COCK 4 WAY,2003216,CDM,272,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
ENDO TUBE 3.0,2003246,CDM,271,RC,,,outpatient,,,4.25,2.13,,4.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,4.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,90,
ENDO TUBE 3.5,2003248,CDM,271,RC,,,outpatient,,,8.75,4.38,,8.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,90,
TRACH TUBE 3.5,2003249,CDM,271,RC,,,outpatient,,,6.25,3.13,,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,90,
TRACH TUBE 4.0,2003251,CDM,271,RC,,,outpatient,,,6.5,3.25,,6.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,90,
TRACH TUBE 4.5,2003253,CDM,271,RC,,,outpatient,,,13.5,6.75,,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,
TRACH TUBE 5.0,2003255,CDM,271,RC,,,outpatient,,,6.25,3.13,,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,90,
TRACH TUBE 5.5,2003257,CDM,271,RC,,,outpatient,,,6.25,3.13,,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,90,
ENDO TUBE 6.0MM,2003258,CDM,271,RC,,,outpatient,,,6.25,3.13,,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,90,
IT CLAMP,2003259,CDM,272,RC,,,outpatient,,,206.25,103.13,,200.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,123.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,185.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,185.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,140.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,123.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,166.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,136.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,167.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,189.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,195.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,200.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,134.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,123.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,123.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,185.63,
TUBE/TRACH 8MM,2003260,CDM,271,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,
MAT TOURNIQUET,2003261,CDM,272,RC,,,outpatient,,,149.25,74.63,,144.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,134.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.33,
TRACH TUBE 7MM,2003262,CDM,271,RC,,,outpatient,,,6.5,3.25,,6.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,90,
TRACH TUBE 6MM,2003264,CDM,271,RC,,,outpatient,,,6,3,,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,
ENDO TUBE 6.5MM,2003270,CDM,271,RC,,,outpatient,,,6.25,3.13,,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,90,
ENDO TUBE 7.0MM,2003272,CDM,271,RC,,,outpatient,,,6.25,3.13,,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,90,
ENDO TUBE 7.5MM,2003274,CDM,271,RC,,,outpatient,,,6.25,3.13,,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,90,
ENDO TUBE 8.0MM,2003276,CDM,271,RC,,,outpatient,,,8.5,4.25,,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,90,
ENDO TUBE 8.5 MM,2003278,CDM,271,RC,,,outpatient,,,6.25,3.13,,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,90,
STYLETTE GUIDE/PED,2003280,CDM,272,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,
STYLETTE /ADULT,2003282,CDM,271,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,
STRADI-TUBE,2003283,CDM,272,RC,,,outpatient,,,48.5,24.25,,47.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,43.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,33.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,29.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,32.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,39.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,44.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,46.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,47.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,29.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,29.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.1,90,
LG VOL NEBULIZER /DISP,2003286,CDM,272,RC,,,outpatient,,,6,3,,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,
AEROCHAMBER,2003290,CDM,271,RC,,,outpatient,,,22,11,,21.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,19.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,21.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.2,90,
NON VENTED FULL FACE MED,2003294,CDM,272,RC,,,outpatient,,,169.75,84.88,,164.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,115.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,137.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,112.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,137.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,156.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,161.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,164.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,110.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,152.78,
NON VENTED FULLFACE LRG,2003295,CDM,272,RC,,,outpatient,,,117,58.5,,113.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,105.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,70.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,107.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,111.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,70.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,70.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,105.3,
NON VENTED FULL FACE SMALL,2003296,CDM,272,RC,,,outpatient,,,117,58.5,,113.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,105.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,70.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,107.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,111.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,70.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,70.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,105.3,
CPAP SUPPLIES MED CPAP MASK,2003297,CDM,272,RC,,,outpatient,,,130,65,,126.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,78,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39,30,,,percent of total billed charges,Pays at 30% of total billed charges,117,90,,,percent of total billed charges,Pays at 90% of total billed charges,117,90,,,percent of total billed charges,Pays at 90% of total billed charges,78,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,88.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,104.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,105.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,119.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,123.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,78,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117,90,,,percent of total billed charges,Pays at 90% of total billed charges,78,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,78,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117,
PEAK FLOW MONITER,2003298,CDM,271,RC,,,outpatient,,,32.75,16.38,,31.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,31.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,90,
EZ IO STABILIZER,2003299,CDM,272,RC,,,outpatient,,,89.5,44.75,,86.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,80.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,53.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,72.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,82.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,85.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,86.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,53.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,53.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.7,90,
SAL OXYGEN-PER HOUR,2003300,CDM,270,RC,,,outpatient,,,25.25,12.63,,24.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.15,90,
EZ IO  NEEDLE 45MM/15GA YELLOW,2003301,CDM,272,RC,,,outpatient,,,326,163,,316.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,195.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,293.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,293.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,195.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,237.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,222.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,195.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,263.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,263.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,288.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,216.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,264.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,299.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,309.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,316.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,211.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,195.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,293.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,195.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,195.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,293.4,
SAL OXYGEN-LONG TERM,2003302,CDM,270,RC,,,outpatient,,,15.5,7.75,,15.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,90,
HI FREQUENCY CHEST VEST,2003304,CDM,270,RC,,,outpatient,,,371.5,185.75,,360.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,222.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,334.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,334.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,270.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,253.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,222.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,299.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,329.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,246.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,300.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,341.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,352.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,360.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,241.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,222.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,334.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,222.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,334.35,
ACAPELLA  MOUTHPIECE GRN,2003305,CDM,270,RC,,,outpatient,,,189.75,94.88,,184.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,170.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,170.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,129.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,113.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,153.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,153.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,168.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,125.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,153.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,174.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,180.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,184.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,123.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,113.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,113.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,170.78,
ACAPELLA  MOUTHPIECE  BLUE,2003306,CDM,272,RC,,,outpatient,,,208.25,104.13,,202,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,187.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,124.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,142.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,124.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,168.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,184.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,138.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,168.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,191.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,197.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,202,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,124.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,124.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,124.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,187.43,
FILTER HIGH EFFIC RESP,2003307,CDM,272,RC,,,outpatient,,,8,4,,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,90,
CANNULA CUSHION INFANT,2003308,CDM,272,RC,,,outpatient,,,7,3.5,,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,90,
HME TYPE II SMALL VOL,2003309,CDM,272,RC,,,outpatient,,,6.75,3.38,,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,90,
MDI ADAPTOR 22MM OD,2003310,CDM,272,RC,,,outpatient,,,9.25,4.63,,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,90,
ADAPTOR VALVED TEE 22MM OD,2003311,CDM,272,RC,,,outpatient,,,15.25,7.63,,14.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.15,90,
EZ IO  NEEDLE 15MM/15GA RED,2003313,CDM,272,RC,,,outpatient,,,332.5,166.25,,322.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,199.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,299.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,299.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,199.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,241.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,226.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,199.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,268.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,268.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,294.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,220.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,269.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,305.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,315.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,322.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,216.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,199.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,199.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,199.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,299.25,
BIPAP MASK FITLIFE LG,2003314,CDM,272,RC,,,outpatient,,,406.25,203.13,,394.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,243.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,365.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,365.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,243.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,295.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,277.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,243.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,327.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,327.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,359.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,269.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,329.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,373.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,385.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,394.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,264.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,243.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,365.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,243.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,243.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,365.63,
COMBITUBE,2003333,CDM,272,RC,,,outpatient,,,392.25,196.13,,380.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,235.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,353.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,353.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,235.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,285.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,267.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,235.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,316.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,316.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,347.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,260.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,317.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,360.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,372.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,380.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,254.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,235.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,353.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,235.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,235.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,353.03,
BOOT WOMENS LARGE DARCO,2003937,CDM,274,RC,,,outpatient,,,20.75,10.38,,20.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,90,
VENTROL LEVIN TUBE 16FR,2004064,CDM,271,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,
VENTROL LEVIN 18FR,2004066,CDM,271,RC,,,outpatient,,,8.25,4.13,,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,90,
VENTROL LEVIN 6FR,2004067,CDM,272,RC,,,outpatient,,,30.25,15.13,,29.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,27.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,27.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.15,90,
FEMALE CATH,2004068,CDM,271,RC,,,outpatient,,,7,3.5,,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,90,
VENTROL LEVIN 8FR,2004069,CDM,272,RC,,,outpatient,,,30,15,,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9,30,,,percent of total billed charges,Pays at 30% of total billed charges,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,27.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,90,
VENTROL LEVIN10FR,2004070,CDM,272,RC,,,outpatient,,,8,4,,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,90,
PED ANDRO-TUBE AN-11,2004072,CDM,271,RC,,,outpatient,,,67,33.5,,64.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,60.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,45.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,40.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,59.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,44.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,54.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,61.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,63.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,64.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,40.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.2,90,
EASY CAP 2 CO2 DETECTOR,2004075,CDM,272,RC,,,outpatient,,,46,23,,44.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,37.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,42.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,90,
E PUMP 100ML PUMP SET,2004076,CDM,271,RC,,,outpatient,,,12.5,6.25,,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,90,
PEDI CAP CO2 DETECTOR,2004077,CDM,272,RC,,,outpatient,,,46,23,,44.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,37.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,42.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,90,
SUCTION TUBE ATTACHM,2004078,CDM,271,RC,,,outpatient,,,11.5,5.75,,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,90,
TUBE SOGASTRIC SUMP 12FR,2004079,CDM,272,RC,,,outpatient,,,12.75,6.38,,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,
LEVIN STOMACH TUBE 18FR,2004080,CDM,271,RC,,,outpatient,,,7,3.5,,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,90,
INF FEEDING TUBE 8FR,2004083,CDM,271,RC,,,outpatient,,,8.5,4.25,,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,90,
GASTRIC LAVAGE KIT,2004085,CDM,271,RC,,,outpatient,,,48.5,24.25,,47.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,43.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,33.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,29.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,32.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,39.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,44.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,46.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,47.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,29.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,29.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.1,90,
TENS UNIT,2004089,CDM,271,RC,,,outpatient,,,121.5,60.75,,117.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,109.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,98.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,111.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,115.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,117.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,109.35,
SPECIMEN TRAP,2004090,CDM,271,RC,,,outpatient,,,18.25,9.13,,17.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,90,
CATH LEG SECUREMENT DEVICE,2004091,CDM,271,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,
LEG BAG /LARGE,2004093,CDM,271,RC,,,outpatient,,,34.5,17.25,,33.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,31.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,32.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.7,90,
CATH ROB-NEL FR 20 FR,2004101,CDM,272,RC,,,outpatient,,,18.25,9.13,,17.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,90,
CATH ROB-NEL FR 24FR,2004102,CDM,272,RC,,,outpatient,,,18.25,9.13,,17.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,90,
CATH ROB-NEL FR 30FR,2004103,CDM,272,RC,,,outpatient,,,18.25,9.13,,17.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,90,
HEIMLICH CH DR VALVE,2004104,CDM,272,RC,,,outpatient,,,191.75,95.88,,186,97,,,percent of total billed charges,Pays at 97% of total billed charges,115.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,172.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,172.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,130.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,115.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,169.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,127.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,155.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,176.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,182.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,186,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,115.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,115.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,172.58,
JUXTALITE SHORT MED,2004105,CDM,272,RC,,,outpatient,,,152.25,76.13,,147.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,137.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,103.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,122.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,100.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,123.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,140.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,144.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,147.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,137.03,
JUXTALITE SHORT LRG,2004107,CDM,272,RC,,,outpatient,,,122,61,,118.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,109.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,98.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,115.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,118.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,109.8,
JUXTALITE LONG MED,2004109,CDM,272,RC,,,outpatient,,,152.25,76.13,,147.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,137.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,103.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,122.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,100.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,123.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,140.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,144.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,147.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,137.03,
JUXTALITE LONG LRG,2004111,CDM,272,RC,,,outpatient,,,130.5,65.25,,126.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,117.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,105.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,120.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,123.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,78.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117.45,
CIRCAID PAC BAND STD,2004113,CDM,271,RC,,,outpatient,,,32.75,16.38,,31.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,31.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,90,
ARGYLE DELEE SUCTION,2004120,CDM,271,RC,,,outpatient,,,8.5,4.25,,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,90,
BILE BAG,2004126,CDM,272,RC,,,outpatient,,,60,30,,58.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,36,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,30,,,percent of total billed charges,Pays at 30% of total billed charges,54,90,,,percent of total billed charges,Pays at 90% of total billed charges,54,90,,,percent of total billed charges,Pays at 90% of total billed charges,36,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,40.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,36,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,53.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,39.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,48.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,55.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,57,95,,,percent of total billed charges,Pays at 95% of total billed charges,58.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,39,65,,,percent of total billed charges,Pays at 65% of total billed charges,36,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54,90,,,percent of total billed charges,Pays at 90% of total billed charges,36,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,36,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36,90,
RECTAL TUBE 24FR RED,2004128,CDM,272,RC,,,outpatient,,,9.5,4.75,,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,90,
EPIFIX 2X2 4 SQ CM GS 5220,2004131,CDM,636,RC,,,outpatient,,,2417.5,1208.75,,2344.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,1450.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2175.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,2175.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,1450.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1758.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1649.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1450.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1951.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1951.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2142.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1602.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1958.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2224.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,2296.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,2344.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,1571.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,1450.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1450.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1450.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2175.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,1450.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1450.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2175.75,
EPIFIX 2X4 8 SQ CM GS 5240,2004132,CDM,636,RC,,,outpatient,,,3155.25,1577.63,,3060.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,1893.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2839.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,2839.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1893.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2295.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2153.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1893.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2546.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2546.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2795.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2091.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2555.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2902.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,2997.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,3060.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,2050.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,1893.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1893.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1893.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2839.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1893.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1893.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2839.73,
EPIFIX 4X4 16 SQ CM GS 5440,2004133,CDM,636,RC,,,outpatient,,,7352,3676,,7131.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,4411.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,6616.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,6616.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,4411.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5349.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5017.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4411.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5934.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5934.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6514.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4874.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5955.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6763.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,6984.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,7131.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,4778.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,4411.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4411.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4411.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6616.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,4411.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4411.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,6616.8,
EPIFIX 5X6 30 SQ CM GS 5560,2004134,CDM,636,RC,,,outpatient,,,13571,6785.5,,13163.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,8142.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,12213.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12213.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,8142.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9874.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9262.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8142.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10954.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10954.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12025.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8997.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10992.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12485.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,12892.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,13163.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,8821.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,8142.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8142.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8142.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12213.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,8142.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8142.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,12213.9,
CATH-FOLEY 14F W/5CC,2004142,CDM,272,RC,,,outpatient,,,21.5,10.75,,20.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.9,90,
CATH-FOLEY 12 FR 5CC  ER,2004143,CDM,272,RC,,,outpatient,,,15.25,7.63,,14.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.15,90,
CATH 16FR 5CC,2004144,CDM,272,RC,,,outpatient,,,15.5,7.75,,15.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,90,
CATH 16FR 5CC LATEX FREE,2004145,CDM,272,RC,,,outpatient,,,36.75,18.38,,35.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,33.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,33.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,90,
CATH 18FR/5CC,2004146,CDM,272,RC,,,outpatient,,,18.25,9.13,,17.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,90,
CATHETER FOLEY 5CC/20FR,2004148,CDM,272,RC,,,outpatient,,,18.5,9.25,,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,90,
CATH-FOLEY 6 FR SILICONE,2004149,CDM,272,RC,,,outpatient,,,7.5,3.75,,7.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,90,
URL CATH 22FR-5CC,2004150,CDM,272,RC,,,outpatient,,,19.75,9.88,,19.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,17.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,18.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.85,90,
CATH-FOLEY 24FR 5CC,2004152,CDM,272,RC,,,outpatient,,,20.25,10.13,,19.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,18.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.15,90,
CATH-FOLEY 26 W/5CC,2004154,CDM,272,RC,,,outpatient,,,21.25,10.63,,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,90,
CATH-FOLEY 14FR/30CC,2004156,CDM,272,RC,,,outpatient,,,3.75,1.88,,3.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,90,
CATHETER TRIPLE LUMN CVP,2004157,CDM,270,RC,,,outpatient,,,132,66,,128.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,118.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,90.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,106.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,121.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,125.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,128.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,118.8,
IMPLANTABLE PORT TITANIUM 9.6,2004159,CDM,272,RC,,,outpatient,,,455.5,227.75,,441.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,273.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,409.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,409.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,273.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,331.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,310.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,273.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,367.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,367.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,403.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,302,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,368.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,419.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,432.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,441.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,296.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,273.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,409.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,273.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,273.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,409.95,
CATH-FOLEY 18FR 30CC,2004160,CDM,272,RC,,,outpatient,,,18,9,,17.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,90,
TUBE SOGASTRIC 10 FR,2004161,CDM,272,RC,,,outpatient,,,57,28.5,,55.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,51.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,34.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,46.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,52.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,54.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,55.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,34.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,34.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.2,90,
CATH-FOLEY 20FR/30CC,2004162,CDM,272,RC,,,outpatient,,,21.5,10.75,,20.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.9,90,
CATHGLAND 10FR 5CC 5CM,2004163,CDM,272,RC,,,outpatient,,,75,37.5,,72.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,67.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,49.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,60.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,69,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,72.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45,90,
CATH-FOLEY 22FR/30CC,2004164,CDM,272,RC,,,outpatient,,,37.5,18.75,,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,34.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,
TUBE SOGASTRIC 12 FR,2004165,CDM,272,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,
CATH-FOLEY 24FR/30CC,2004166,CDM,272,RC,,,outpatient,,,40.75,20.38,,39.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.45,90,
CATH-FOLEY 30CC 28FR,2004170,CDM,272,RC,,,outpatient,,,23.75,11.88,,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,90,
CATH 20 FR/30CC,2004174,CDM,272,RC,,,outpatient,,,46,23,,44.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,37.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,42.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,90,
CATH 30 FR 30CC,2004176,CDM,272,RC,,,outpatient,,,50.25,25.13,,48.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,45.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,40.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,46.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,47.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,48.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,90,
CATH 24FR-30CC,2004178,CDM,272,RC,,,outpatient,,,47,23.5,,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,38.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,43.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,90,
CATH 26FR-30CC,2004180,CDM,272,RC,,,outpatient,,,55.25,27.63,,53.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,49.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,44.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,50.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,52.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,53.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.15,90,
SILICONE FOLEY CATH,2004181,CDM,272,RC,,,outpatient,,,46.5,23.25,,45.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,41.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,37.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,42.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.9,90,
CATHETER FOL SIL 8FR/3CC,2004182,CDM,272,RC,,,outpatient,,,15.75,7.88,,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,90,
CATHETER SIL 20FR 30CC,2004183,CDM,272,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
CATH-UMBILICAL 3.5 FR,2004184,CDM,272,RC,,,outpatient,,,52.5,26.25,,50.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,35.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,49.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,50.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.5,90,
CATHETER FOL SIL 16FR 5CC,2004185,CDM,272,RC,,,outpatient,,,55.5,27.75,,53.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,49.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,44.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,51.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,52.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,53.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,33.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.3,90,
CATH-UMBILICAL/5.0FR,2004186,CDM,272,RC,,,outpatient,,,52.5,26.25,,50.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,35.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,49.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,50.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.5,90,
UMBILICAL CATH 8FR TRIPLE LUMEN,2004188,CDM,272,RC,,,outpatient,,,45.5,22.75,,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,41.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,90,
CATH COUDE 14FR,2004190,CDM,272,RC,,,outpatient,,,37.5,18.75,,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,34.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,
CATH COUDE 12FR,2004191,CDM,272,RC,,,outpatient,,,36.75,18.38,,35.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,33.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,33.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,90,
CATH COUDE 16FR,2004192,CDM,272,RC,,,outpatient,,,36.25,18.13,,35.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,32.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,33.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.75,90,
FEEDING TUBE 18 FR MIC,2004193,CDM,272,RC,,,outpatient,,,144.5,72.25,,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.05,
CATH COUDE 18FR,2004194,CDM,272,RC,,,outpatient,,,38.25,19.13,,37.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,35.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,36.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.95,90,
FEEDING TUBE 16 FR MIC,2004195,CDM,272,RC,,,outpatient,,,144.5,72.25,,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.05,
BARD CATH 30CC/18FR,2004196,CDM,272,RC,,,outpatient,,,18.25,9.13,,17.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,90,
FEEDING TUBE 14 FR MIC,2004197,CDM,272,RC,,,outpatient,,,172,86,,166.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,154.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,154.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,117.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,138.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,139.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,158.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,163.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,166.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,154.8,
BARD CATH 30CC/20FR,2004198,CDM,272,RC,,,outpatient,,,23,11.5,,22.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,20.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.8,90,
FEEDING TUBE 20 FR MIC,2004199,CDM,272,RC,,,outpatient,,,172,86,,166.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,154.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,154.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,117.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,138.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,139.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,158.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,163.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,166.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,154.8,
BARD CATH 30CC/22FR,2004200,CDM,272,RC,,,outpatient,,,23.75,11.88,,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,90,
FEEDING TUBE 12 FR MIC,2004201,CDM,272,RC,,,outpatient,,,172,86,,166.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,154.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,154.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,117.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,138.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,139.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,158.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,163.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,166.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,154.8,
BARD CATH 30CC/24FR,2004202,CDM,272,RC,,,outpatient,,,35,17.5,,33.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,21,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,31.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,21,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,21,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,21,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21,90,
CATH 12FR 5CC,2004203,CDM,272,RC,,,outpatient,,,48.75,24.38,,47.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,43.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,33.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,32.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,39.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,44.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,46.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,47.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,90,
CATH BARD 30CC/26FR,2004204,CDM,272,RC,,,outpatient,,,32.75,16.38,,31.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,31.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,90,
CATH-5FR OPEN END,2004205,CDM,272,RC,,,outpatient,,,58.25,29.13,,56.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,52.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,47.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,53.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,55.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,56.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.95,90,
SUTUREmonosof  4.0 18IN p-12,2004207,CDM,272,RC,,,outpatient,,,61.25,30.63,,59.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,55.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,41.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,36.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,40.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,49.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,56.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,58.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,59.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,36.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,36.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.75,90,
SUTURE SILK2.0 3030 BLACK,2004208,CDM,272,RC,,,outpatient,,,9.5,4.75,,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,90,
SUTURE SILK3.0  BLACK,2004209,CDM,272,RC,,,outpatient,,,6,3,,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,
SUTURE SILK4.0 30 BLACK,2004210,CDM,272,RC,,,outpatient,,,10.5,5.25,,10.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,90,
SUTURE POLYSORB 4.0 CV-23,2004212,CDM,272,RC,,,outpatient,,,176.5,88.25,,171.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,158.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,158.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,117.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,142.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,162.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,171.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,158.85,
SUTURE MONOCRYL 4.0 18 UNDYN,2004213,CDM,272,RC,,,outpatient,,,23.75,11.88,,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,90,
SUTUREMONOSOF3.0P-12 NYLON CUTTING,2004214,CDM,272,RC,,,outpatient,,,21,10.5,,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,90,
SUTURE MONO SOF 5.0 SN3965,2004215,CDM,272,RC,,,outpatient,,,14.25,7.13,,13.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,90,
TAPE UMBILICAL 1/8x36,2004216,CDM,272,RC,,,outpatient,,,11,5.5,,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,90,
CATH 10FR 5CC,2004217,CDM,272,RC,,,outpatient,,,37,18.5,,35.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,34.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.2,90,
CATH 8FR 5CC,2004218,CDM,272,RC,,,outpatient,,,37,18.5,,35.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,34.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.2,90,
SUTURE SILK 2.0 BLACK PRECUT,2004219,CDM,272,RC,,,outpatient,,,8.5,4.25,,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,90,
SUTURE 4-0 BIOSYN P12,2004220,CDM,272,RC,,,outpatient,,,13.5,6.75,,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,
SUTUREPOLYSORB 0 GU-46,2004221,CDM,272,RC,,,outpatient,,,8.5,4.25,,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,90,
SUTURE MAXON GS-21 3.5,2004222,CDM,272,RC,,,outpatient,,,10.5,5.25,,10.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,90,
SUTURE MAXON GS-21 1,2004223,CDM,272,RC,,,outpatient,,,11.75,5.88,,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,90,
SUTURE MAXON GS-23 0,2004224,CDM,272,RC,,,outpatient,,,11.25,5.63,,10.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,90,
SUTURE MAXON GS-24 SZ1,2004225,CDM,272,RC,,,outpatient,,,11.75,5.88,,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,90,
SUTURE BIOSYN 2.0  V-20,2004226,CDM,272,RC,,,outpatient,,,10.25,5.13,,9.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.15,90,
RELOAD CURVED BLACK,2004227,CDM,272,RC,,,outpatient,,,1058.75,529.38,,1026.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,635.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,317.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,952.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,952.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,635.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,770.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,722.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,635.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,854.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,854.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,938.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,701.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,857.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,974.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,1005.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,1026.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,688.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,635.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,635.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,635.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,952.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,635.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,635.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,952.88,
SUTURE MAXON C 1 SZ4.0,2004228,CDM,272,RC,,,outpatient,,,32.5,16.25,,31.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,29.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,29.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,30.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,31.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.5,90,
SUTURE MAXON C13 SZ4.0,2004229,CDM,272,RC,,,outpatient,,,10.5,5.25,,10.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,90,
THORACIC CATHETER28,2004230,CDM,272,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,90,
THORACIC CATHETER SCOOP TIP REDDICK CATH,2004231,CDM,272,RC,,,outpatient,,,325.25,162.63,,315.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,195.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,292.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,292.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,195.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,236.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,221.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,195.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,262.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,288.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,215.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,263.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,299.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,308.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,315.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,211.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,195.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,292.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,195.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,195.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,292.73,
THORACIC CATHETER 32,2004232,CDM,272,RC,,,outpatient,,,31,15.5,,30.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,90,
THORACIC CATHETER 12,2004233,CDM,272,RC,,,outpatient,,,84,42,,81.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,75.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,57.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,55.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,68.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,77.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,79.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,81.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.4,90,
THORACIC CATH 36FR,2004234,CDM,272,RC,,,outpatient,,,34,17,,32.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,31.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,32.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.4,90,
THORACIC CATHETER 20FR,2004235,CDM,272,RC,,,outpatient,,,83.75,41.88,,81.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,75.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,57.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,55.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,67.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,77.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,79.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,81.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.25,90,
SUTURE CHROMIC GUT 5.0 BCV-23,2004237,CDM,272,RC,,,outpatient,,,8.5,4.25,,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,90,
SUTURE VICRL 2-0 CTX COATED 8-18IN,2004239,CDM,272,RC,,,outpatient,,,151.25,75.63,,146.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,136.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,103.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,122.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,100.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,122.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,139.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,143.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,146.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,136.13,
CATH THORASIC16 FR,2004240,CDM,272,RC,,,outpatient,,,83.75,41.88,,81.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,75.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,57.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,55.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,67.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,77.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,79.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,81.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.25,90,
SUTURE 0 POLYSORB GS22 UNDYED,2004241,CDM,272,RC,,,outpatient,,,7.5,3.75,,7.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,90,
SUTURE SOFSILK 4-0 V-20 BLACK 181N,2004243,CDM,272,RC,,,outpatient,,,27.5,13.75,,26.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,90,
SUTURE MAXON C16 SZ2.0,2004245,CDM,272,RC,,,outpatient,,,10.75,5.38,,10.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,90,
SUTURE MONOSOF4.0 CLEAR P13,2004246,CDM,272,RC,,,outpatient,,,11.5,5.75,,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,90,
GAUZE/IODOFORM 1/2,2004248,CDM,272,RC,,,outpatient,,,9.25,4.63,,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,90,
GAUZE/IODOFORM 1/4'',2004249,CDM,272,RC,,,outpatient,,,7.25,3.63,,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,90,
THROACIC CATH 16FR 18'',2004250,CDM,272,RC,,,outpatient,,,21,10.5,,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,90,
THROACIC CATH R ANGLE 16'',2004251,CDM,272,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
THROACIC CATH 28FR 23'',2004252,CDM,272,RC,,,outpatient,,,21,10.5,,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,90,
THROACIC CATH R ANGLE 28FR23'',2004253,CDM,272,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
GAUZE/IODOFORM 1,2004254,CDM,272,RC,,,outpatient,,,10,5,,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,30,,,percent of total billed charges,Pays at 30% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,90,
FUHRMAN PLEUAL/DRAIGE,2004255,CDM,272,RC,,,outpatient,,,257.75,128.88,,250.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,154.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,231.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,231.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,154.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.54,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,175.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,154.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,228.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,170.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,208.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,237.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,244.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,250.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,167.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,154.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,231.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,154.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,154.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,231.98,
GAUZE/IODOFORM 2,2004256,CDM,272,RC,,,outpatient,,,15.75,7.88,,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,90,
LENS MORGAN THERAPEU,2004274,CDM,271,RC,,,outpatient,,,187.25,93.63,,181.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,168.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,127.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,151.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,165.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,124.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,151.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,172.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,177.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,181.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,112.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,168.53,
THORACIC CATHETER 20FR,2004275,CDM,272,RC,,,outpatient,,,27.75,13.88,,26.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,90,
THORACIC CATHETER 24FR SHARP,2004276,CDM,272,RC,,,outpatient,,,77,38.5,,74.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,51.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,62.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,73.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.2,90,
THORACIC CATHETER 28FR SHARP,2004277,CDM,272,RC,,,outpatient,,,27.75,13.88,,26.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,90,
TROCAR CATHETER 32FR SHARP,2004278,CDM,272,RC,,,outpatient,,,77,38.5,,74.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,51.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,62.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,73.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,46.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.2,90,
FINGER SPLINT 4-PRONG,2004285,CDM,271,RC,,,outpatient,,,5.5,2.75,,5.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,90,
KERLIX SUPER SPONGE,2004299,CDM,272,RC,,,outpatient,,,12.5,6.25,,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,90,
GAUZE KLING STER 6,2004304,CDM,272,RC,,,outpatient,,,2.5,1.25,,2.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.5,90,
DRAIN MALECOT 20FR 4WING,2004305,CDM,272,RC,,,outpatient,,,119.75,59.88,,116.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,107.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,81.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,113.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,107.78,
DRAIN MALECOT 14FR 4WING,2004307,CDM,272,RC,,,outpatient,,,119.75,59.88,,116.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,107.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,81.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,113.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,107.78,
DRAIN MALECOT 10FR 4WING,2004308,CDM,272,RC,,,outpatient,,,119.75,59.88,,116.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,107.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,81.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,113.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,107.78,
XERFORM 5X9,2004368,CDM,272,RC,,,outpatient,,,1.75,0.88,,1.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,1.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.27,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,1.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,1.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,90,
GAUZE-VAS 6 X36,2004376,CDM,272,RC,,,outpatient,,,9.25,4.63,,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,90,
ADAPTIC DRESSING 3X8,2004383,CDM,272,RC,,,outpatient,,,6.75,3.38,,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,90,
DRESSING TAGADERM 4X5,2004384,CDM,272,RC,,,outpatient,,,8.5,4.25,,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,90,
TEGADERM 2X2,2004386,CDM,272,RC,,,outpatient,,,14.75,7.38,,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,90,
SUGIFOAM,2004389,CDM,272,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
DRESSING TAGADERM7 7/8 X8,2004390,CDM,272,RC,,,outpatient,,,43.5,21.75,,42.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,39.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.1,90,
DRESSING  CUTICERIN,2004399,CDM,272,RC,,,outpatient,,,5.75,2.88,,5.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,90,
LUBE JELLY 2 OZ,2004400,CDM,271,RC,,,outpatient,,,7.25,3.63,,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,90,
SUTURE V-LOC 180 4-0 23''CLEAR P-14,2004409,CDM,272,RC,,,outpatient,,,113.5,56.75,,110.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,102.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,102.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,75.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,104.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,107.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,110.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.15,
DISP LOOP ELECTRODE 1X1,2004492,CDM,271,RC,,,outpatient,,,58.5,29.25,,56.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,52.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,47.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,53.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,55.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,56.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.1,90,
DISP LOOP ELEC 1.5 X 1.5,2004493,CDM,271,RC,,,outpatient,,,38.75,19.38,,37.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,34.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,23.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,31.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,35.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,36.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,23.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.25,90,
NEEDLE INJECTION,2004511,CDM,272,RC,,,outpatient,,,226,113,,219.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,203.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,154.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,183.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,207.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,214.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,219.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,203.4,
BONE SCREW 2.3X16MM CROSSPIN SELF T,2004512,CDM,270,RC,,,outpatient,,,301.75,150.88,,292.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,271.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,271.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,219.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,205.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,267.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,200.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,244.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,277.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,286.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,292.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,196.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,271.58,
BONE SCREW 2.3X18MM CROSSPIN SELF T,2004513,CDM,270,RC,,,outpatient,,,80,40,,77.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24,30,,,percent of total billed charges,Pays at 30% of total billed charges,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,76,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52,65,,,percent of total billed charges,Pays at 65% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,90,
BONE SCREW 2.3X20MM CROSSPIN SELF T,2004514,CDM,270,RC,,,outpatient,,,80,40,,77.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24,30,,,percent of total billed charges,Pays at 30% of total billed charges,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,76,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52,65,,,percent of total billed charges,Pays at 65% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,90,
BONE SCREW 2.3X22MM CROSSPIN SELF T,2004515,CDM,270,RC,,,outpatient,,,80,40,,77.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24,30,,,percent of total billed charges,Pays at 30% of total billed charges,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,76,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52,65,,,percent of total billed charges,Pays at 65% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,90,
BONE SCREW 2.3X24MM CROSSPIN SELF T,2004516,CDM,270,RC,,,outpatient,,,80,40,,77.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24,30,,,percent of total billed charges,Pays at 30% of total billed charges,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,76,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52,65,,,percent of total billed charges,Pays at 65% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,90,
BONE SCREW 2.3X26MM CROSSPIN SELF T,2004517,CDM,270,RC,,,outpatient,,,80,40,,77.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24,30,,,percent of total billed charges,Pays at 30% of total billed charges,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,76,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52,65,,,percent of total billed charges,Pays at 65% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,90,
EMERG SCREW 2.5X6MM CROSSPIN SELF T,2004518,CDM,270,RC,,,outpatient,,,79.75,39.88,,77.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.85,90,
EMERG SCREW 2.5X8MM CROSSPIN SELF T,2004519,CDM,270,RC,,,outpatient,,,79.75,39.88,,77.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.85,90,
EMERG SCREW 2.5X10MM CROSSPIN SELF T,2004520,CDM,270,RC,,,outpatient,,,79.75,39.88,,77.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.85,90,
EMERG SCREW 2.5X12MM CROSSPIN SELF T,2004521,CDM,270,RC,,,outpatient,,,79.75,39.88,,77.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.85,90,
WASHER FOR 1.7MM BONE SCREW,2004522,CDM,270,RC,,,outpatient,,,36.5,18.25,,35.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,33.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,90,
WASHER FOR 2.3MM BONE SCREW,2004523,CDM,270,RC,,,outpatient,,,36.5,18.25,,35.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,33.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,90,
TWIST DRILL 1.4MM DIA AO,2004524,CDM,270,RC,,,outpatient,,,372.25,186.13,,361.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,223.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,335.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,335.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,223.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,270.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,254.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,223.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,300.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,300.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,329.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,246.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,301.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,342.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,353.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,361.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,241.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,223.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,335.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,223.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,223.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,335.03,
TWIST DRILL 1.9MM DIA AO,2004525,CDM,270,RC,,,outpatient,,,232.25,116.13,,225.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,209.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,158.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,187.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,205.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,153.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,188.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,213.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,220.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,225.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,150.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,209.03,
TWIST DRILL 2.5MM DIA AO,2004526,CDM,270,RC,,,outpatient,,,628.25,314.13,,609.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,376.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,565.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,565.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,376.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,457.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,428.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,376.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,507.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,507.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,556.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,416.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,508.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,577.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,596.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,609.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,408.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,376.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,376.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,376.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,565.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,376.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,376.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,565.43,
COUNTERSINK / W/ DENTALSHAFT 1.7,2004527,CDM,270,RC,,,outpatient,,,124,62,,120.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,111.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,84.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,74.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,109.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,82.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,100.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,114.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,117.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,120.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,74.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,74.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,111.6,
COUNTERSINK / W/ DENTALSHAFT END,2004528,CDM,270,RC,,,outpatient,,,124,62,,120.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,111.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,84.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,74.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,109.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,82.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,100.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,114.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,117.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,120.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,74.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,74.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,111.6,
K WIRE 3.2X450MM STERILE,2004529,CDM,270,RC,,,outpatient,,,273.25,136.63,,265.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,163.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,245.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,245.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,186.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,163.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,220.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,220.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,242.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,181.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,221.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,251.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,259.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,265.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,177.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,163.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,245.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,163.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,245.93,
K WIRE 3MMX285MM STERILE,2004530,CDM,270,RC,,,outpatient,,,110,55,,106.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33,30,,,percent of total billed charges,Pays at 30% of total billed charges,99,90,,,percent of total billed charges,Pays at 90% of total billed charges,99,90,,,percent of total billed charges,Pays at 90% of total billed charges,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,75.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,72.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,89.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,101.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,104.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,106.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99,90,,,percent of total billed charges,Pays at 90% of total billed charges,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,99,
T 2 HUMERAL STERILE TEFLON TUBE,2004531,CDM,270,RC,,,outpatient,,,225.25,112.63,,218.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,202.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,153.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,181.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,199.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,182.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,207.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,213.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,218.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,135.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,202.73,
GUIDE WIRE BALL TIP 3.0X800MM ST,2004532,CDM,270,RC,,,outpatient,,,397.25,198.63,,385.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,238.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,357.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,357.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,238.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,289.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,271.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,238.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,320.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,352,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,263.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,321.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,365.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,377.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,385.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,258.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,238.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,357.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,238.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,238.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,357.53,
GUIDE WIRE SMOOTH TIP 3.0X800MM ST,2004533,CDM,270,RC,,,outpatient,,,116.25,58.13,,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,104.63,
DRILL BIT 3.5X230MM AO/ST,2004534,CDM,270,RC,,,outpatient,,,116.25,58.13,,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,104.63,
DRILL BIT 3.5X130MM AO/ST,2004535,CDM,270,RC,,,outpatient,,,116.25,58.13,,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,104.63,
DRILL BIT 3.5X180MM AO/ST,2004536,CDM,270,RC,,,outpatient,,,600.75,300.38,,582.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,360.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,540.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,540.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,360.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,437.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,410.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,360.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,484.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,484.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,532.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,398.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,486.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,552.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,570.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,582.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,390.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,360.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,360.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,360.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,540.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,360.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,360.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,540.68,
DRILL BIT 4.2X260MM AO/ST,2004537,CDM,270,RC,,,outpatient,,,628.25,314.13,,609.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,376.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,565.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,565.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,376.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,457.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,428.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,376.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,507.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,507.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,556.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,416.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,508.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,577.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,596.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,609.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,408.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,376.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,376.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,376.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,565.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,376.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,376.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,565.43,
DRILL BIT 4.2X340MM AO/ST,2004538,CDM,270,RC,,,outpatient,,,159.75,79.88,,154.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,143.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,143.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,109.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,95.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,105.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,129.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,146.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,151.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,154.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,95.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,95.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,143.78,
DRILL BIT 4.2X130MM AO/ST,2004539,CDM,270,RC,,,outpatient,,,632.75,316.38,,613.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,379.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,189.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,569.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,569.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,379.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,460.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,431.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,379.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,510.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,510.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,560.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,419.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,512.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,582.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,601.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,613.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,411.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,379.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,379.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,379.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,569.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,379.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,379.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,569.48,
DRILL BIT 4.2X180MM AO/ST,2004540,CDM,270,RC,,,outpatient,,,166,83,,161.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,149.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,99.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,134.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,152.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,157.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,161.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,107.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,99.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,99.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,149.4,
T2 ADV COMP SCREW TIBIA,2004541,CDM,270,RC,,,outpatient,,,168.75,84.38,,163.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,151.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,151.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,115.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,149.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,111.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,136.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,155.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,160.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,163.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,151.88,
T2 STANDARED END CAP 8MM,2004542,CDM,270,RC,,,outpatient,,,168.75,84.38,,163.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,151.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,151.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,115.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,149.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,111.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,136.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,155.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,160.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,163.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,151.88,
T2 +STANDARD END CAP,2004543,CDM,270,RC,,,outpatient,,,168.75,84.38,,163.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,151.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,151.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,115.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,149.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,111.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,136.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,155.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,160.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,163.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,151.88,
T2 + 10MM END CAP,2004544,CDM,270,RC,,,outpatient,,,168.75,84.38,,163.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,151.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,151.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,115.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,149.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,111.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,136.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,155.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,160.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,163.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,151.88,
T2 STD TIBIAL IL 8MMX240MM,2004546,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 8MMX255MM,2004547,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 8MMX270MM,2004548,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 8MMX285MM,2004549,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 8MMX300MM,2004550,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 8MMX315MM,2004551,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 8MMX330MM,2004552,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 8MMX345MM,2004553,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 8MMX360MM,2004554,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 8MMX375MM,2004555,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 8MMX390MM,2004556,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 8MMX405MM,2004557,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 8MMX420MM,2004558,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 9MMX270MM,2004559,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 9MMX285MM,2004560,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 9MMX300MM,2004561,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 9MMX315MM,2004562,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 9MMX330MM,2004563,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 9MMX345MM,2004564,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 9MMX360MM,2004565,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 9MMX375MM,2004566,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 9MMX390MM,2004567,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 9MMX405MM,2004568,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 9MMX420MM,2004569,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 10MMX270MM,2004570,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 10MMX285MM,2004571,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 10MMX300MM,2004572,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 10MMX315MM,2004573,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 10MMX330MM,2004574,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 10MMX345MM,2004575,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 10MMX360MM,2004576,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 10MMX375MM,2004577,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 10MMX390MM,2004578,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 10MMX405MM,2004579,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 10MMX420MM,2004580,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 11MMX270MM,2004581,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 11MMX285MM,2004582,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 11MMX300MM,2004583,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 11MMX315MM,2004584,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 11MMX330MM,2004585,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 11MMX345MM,2004586,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 11MMX360MM,2004587,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 11MMX375MM,2004588,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 11MMX390MM,2004589,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 11MMX405MM,2004590,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 11MMX420MM,2004591,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 12MMX270MM,2004592,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 12MMX285MM,2004593,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 12MMX300MM,2004594,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 12MMX315MM,2004595,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 12MMX330MM,2004596,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 12MMX345MM,2004597,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 12MMX360MM,2004598,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 12MMX375MM,2004599,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 12MMX390MM,2004600,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 12MMX405MM,2004601,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 STD TIBIAL IL 12MMX420MM,2004602,CDM,270,RC,,,outpatient,,,667.75,333.88,,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.98,
T2 SHAFT SCREW 5MMX25MM,2004603,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
T2 SHAFT SCREW 5MMX30MM,2004604,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
T2 SHAFT SCREW 5MMX35MM,2004605,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
T2 SHAFT SCREW 5MMX40MM,2004606,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
T2 SHAFT SCREW 5MMX45MM,2004607,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
T2 SHAFT SCREW 5MMX50MM,2004608,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
T2 SHAFT SCREW 5MMX55MM,2004609,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
T2 SHAFT SCREW 5MMX60MM,2004610,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
T2 SHAFT SCREW 5MMX65MM,2004611,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
T2 SHAFT SCREW 5MMX70MM,2004612,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
T2 SHAFT SCREW 5MMX75MM,2004613,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
T2 SHAFT SCREW 5MMX80MM,2004614,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
T2 F/T LOCKING SCREW 4MMX20MM,2004615,CDM,270,RC,,,outpatient,,,169.75,84.88,,164.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,115.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,137.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,112.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,137.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,156.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,161.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,164.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,110.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,152.78,
T2 F/T LOCKING SCREW 4MMX25MM,2004616,CDM,270,RC,,,outpatient,,,169.75,84.88,,164.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,115.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,137.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,112.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,137.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,156.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,161.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,164.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,110.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,152.78,
T2 F/T LOCKING SCREW 4MMX30MM,2004617,CDM,270,RC,,,outpatient,,,169.75,84.88,,164.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,115.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,137.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,112.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,137.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,156.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,161.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,164.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,110.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,152.78,
T2 F/T LOCKING SCREW 4MMX35MM,2004618,CDM,270,RC,,,outpatient,,,169.75,84.88,,164.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,115.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,137.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,112.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,137.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,156.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,161.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,164.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,110.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,152.78,
T2 F/T LOCKING SCREW 4MMX40MM,2004619,CDM,270,RC,,,outpatient,,,169.75,84.88,,164.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,115.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,137.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,112.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,137.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,156.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,161.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,164.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,110.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,152.78,
T2 F/T LOCKING SCREW 4MMX45MM,2004620,CDM,270,RC,,,outpatient,,,169.75,84.88,,164.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,115.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,137.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,112.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,137.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,156.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,161.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,164.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,110.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,152.78,
T2 F/T LOCKING SCREW 4MMX50MM,2004621,CDM,270,RC,,,outpatient,,,169.75,84.88,,164.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,115.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,137.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,112.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,137.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,156.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,161.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,164.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,110.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,152.78,
T2 F/T LOCKING SCREW 4MMX55MM,2004622,CDM,270,RC,,,outpatient,,,169.75,84.88,,164.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,115.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,137.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,112.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,137.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,156.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,161.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,164.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,110.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,152.78,
T2 F/T LOCKING SCREW 4MMX60MM,2004623,CDM,270,RC,,,outpatient,,,169.75,84.88,,164.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,115.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,137.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,112.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,137.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,156.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,161.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,164.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,110.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,101.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,152.78,
T2 F/T LOCKING SCREW 5MMX25MM,2004624,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
T2 F/T LOCKING SCREW 5MMX27.5MM,2004625,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
T2 F/T LOCKING SCREW 5MMX30MM,2004626,CDM,270,RC,,,outpatient,,,633.5,316.75,,614.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,380.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,570.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,570.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,380.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,460.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,432.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,380.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,511.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,511.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,561.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,420.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,513.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,582.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,601.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,614.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,411.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,380.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,380.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,380.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,570.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,380.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,380.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,570.15,
T2 F/T LOCKING SCREW 5MMX32.5MM,2004627,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
T2 F/T LOCKING SCREW 5MMX35MM,2004628,CDM,270,RC,,,outpatient,,,349.5,174.75,,339.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,314.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,314.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,238.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,282.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,282.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,309.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,231.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,283.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,321.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,332.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,339.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,227.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,314.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,314.55,
T2 F/T LOCKING SCREW 5MMX37.5MM,2004629,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
T2 F/T LOCKING SCREW 5MMX40MM,2004630,CDM,270,RC,,,outpatient,,,652.5,326.25,,632.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,587.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,587.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,474.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,445.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,526.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,526.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,578.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,432.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,528.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,600.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,619.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,632.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,424.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,587.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,587.25,
T2 F/T LOCKING SCREW 5MMX42.5MM,2004631,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
T2 F/T LOCKING SCREW 5MMX45MM,2004632,CDM,270,RC,,,outpatient,,,652.5,326.25,,632.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,587.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,587.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,474.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,445.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,526.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,526.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,578.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,432.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,528.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,600.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,619.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,632.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,424.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,587.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,587.25,
T2 F/T LOCKING SCREW 5MMX47.5MM,2004633,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
T2 F/T LOCKING SCREW 5MMX50MM,2004634,CDM,278,RC,,,outpatient,,,652.5,326.25,,632.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,587.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,587.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,474.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,445.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,526.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,526.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,578.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,432.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,528.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,600.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,619.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,632.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,424.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,587.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,391.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,587.25,
T2 F/T LOCKING SCREW 5MMX52.5MM,2004635,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
T2 F/T LOCKING SCREW 5MMX55MM,2004636,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
T2 F/T LOCKING SCREW 5MMX57.5MM,2004637,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
T2 F/T LOCKING SCREW 5MMX60MM,2004638,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
T2 F/T LOCKING SCREW 5MMX65MM,2004639,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
T2 F/T LOCKING SCREW 5MMX70MM,2004640,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
T2 F/T LOCKING SCREW 5MMX75MM,2004641,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
T2 F/T LOCKING SCREW 5MMX80MM,2004642,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
GUIDE WIRE BALL TIP,2004643,CDM,270,RC,,,outpatient,,,176,88,,170.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,116.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,142.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,161.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,170.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,158.4,
ACCOLADE II SZ 0 132 DEG,2004644,CDM,270,RC,,,outpatient,,,1965.25,982.63,,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1429.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1341.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1741.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1302.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1591.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1808.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1866.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1277.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1768.73,
ACCOLADE II SZ 1 132 DEG,2004645,CDM,270,RC,,,outpatient,,,1965.25,982.63,,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1429.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1341.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1741.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1302.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1591.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1808.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1866.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1277.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1768.73,
ACCOLADE II SZ 2 132 DEG,2004646,CDM,270,RC,,,outpatient,,,1965.25,982.63,,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1429.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1341.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1741.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1302.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1591.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1808.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1866.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1277.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1768.73,
ACCOLADE II SZ 3 132 DEG,2004647,CDM,270,RC,,,outpatient,,,1965.25,982.63,,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1429.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1341.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1741.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1302.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1591.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1808.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1866.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1277.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1768.73,
ACCOLADE II SZ 4 132 DEG,2004648,CDM,270,RC,,,outpatient,,,1965.25,982.63,,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1429.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1341.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1741.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1302.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1591.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1808.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1866.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1277.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1768.73,
ACCOLADE II SZ 5 132 DEG,2004649,CDM,270,RC,,,outpatient,,,1965.25,982.63,,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1429.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1341.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1741.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1302.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1591.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1808.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1866.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1277.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1768.73,
ACCOLADE II SZ 6 132 DEG,2004650,CDM,270,RC,,,outpatient,,,1965.25,982.63,,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1429.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1341.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1741.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1302.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1591.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1808.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1866.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1277.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1768.73,
ACCOLADE II SZ 7 132 DEG,2004651,CDM,270,RC,,,outpatient,,,1965.25,982.63,,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1429.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1341.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1741.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1302.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1591.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1808.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1866.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1277.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1768.73,
ACCOLADE II SZ 8 132 DEG,2004652,CDM,270,RC,,,outpatient,,,1965.25,982.63,,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1429.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1341.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1741.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1302.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1591.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1808.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1866.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1277.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1768.73,
ACCOLADE II SZ 9 132 DEG,2004653,CDM,270,RC,,,outpatient,,,1965.25,982.63,,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1429.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1341.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1741.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1302.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1591.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1808.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1866.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1277.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1768.73,
ACCOLADE II SZ 10 132 DEG,2004654,CDM,270,RC,,,outpatient,,,1965.25,982.63,,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1429.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1341.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1741.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1302.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1591.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1808.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1866.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1277.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1768.73,
ACCOLADE II SZ 11 132 DEG,2004655,CDM,270,RC,,,outpatient,,,1965.25,982.63,,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1429.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1341.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1741.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1302.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1591.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1808.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1866.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1277.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1768.73,
ACCOLADE II SZ 0 127 DEG,2004656,CDM,270,RC,,,outpatient,,,1965.25,982.63,,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1429.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1341.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1741.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1302.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1591.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1808.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1866.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1277.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1768.73,
ACCOLADE II SZ 1 127 DEG,2004657,CDM,270,RC,,,outpatient,,,1965.25,982.63,,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1429.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1341.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1741.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1302.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1591.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1808.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1866.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1277.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1768.73,
ACCOLADE II SZ 2 127 DEG,2004658,CDM,270,RC,,,outpatient,,,1965.25,982.63,,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1429.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1341.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1741.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1302.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1591.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1808.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1866.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1277.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1768.73,
ACCOLADE II SZ 3 127 DEG,2004659,CDM,270,RC,,,outpatient,,,1965.25,982.63,,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1429.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1341.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1741.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1302.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1591.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1808.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1866.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1277.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1768.73,
ACCOLADE II SZ 4 127 DEG,2004660,CDM,270,RC,,,outpatient,,,1965.25,982.63,,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1429.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1341.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1741.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1302.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1591.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1808.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1866.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1277.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1768.73,
ACCOLADE II SZ 5 127 DEG,2004661,CDM,278,RC,,,outpatient,,,11963.25,5981.63,,11604.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,7177.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,10766.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,10766.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,7177.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8704.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8164.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7177.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9656.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9656.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10600.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7931.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9690.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11006.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,11365.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,11604.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,7776.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,7177.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7177.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7177.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10766.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,7177.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7177.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,10766.93,
ACCOLADE II Sz 6 127 DEG,2004662,CDM,270,RC,,,outpatient,,,11615.5,5807.75,,11267.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,6969.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3484.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,10453.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,10453.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,6969.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8451.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7927.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6969.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9376.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9376.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10292.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7701.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9408.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10686.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,11034.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,11267.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,7550.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,6969.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6969.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6969.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10453.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,6969.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6969.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,10453.95,
ACCOLADE II Sz 7 127 DEG,2004663,CDM,270,RC,,,outpatient,,,1965.25,982.63,,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1429.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1341.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1741.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1302.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1591.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1808.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1866.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1277.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1768.73,
ACCOLADE II Sz 8 127 DEG,2004664,CDM,270,RC,,,outpatient,,,1965.25,982.63,,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1429.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1341.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1741.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1302.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1591.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1808.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1866.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1277.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1768.73,
ACCOLADE II Sz 9 127 DEG,2004665,CDM,270,RC,,,outpatient,,,1965.25,982.63,,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1429.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1341.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1741.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1302.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1591.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1808.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1866.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1277.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1768.73,
ACCOLADE II Sz 10 127 DEG,2004666,CDM,270,RC,,,outpatient,,,1965.25,982.63,,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1429.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1341.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1741.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1302.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1591.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1808.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1866.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1277.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1768.73,
ACCOLADE II Sz 11 127 DEG,2004667,CDM,270,RC,,,outpatient,,,1965.25,982.63,,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1429.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1341.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1741.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1302.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1591.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1808.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1866.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1277.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1768.73,
TI CANNULATED SCREW 6.5X40MM,2004668,CDM,270,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.45,
TI CANNULATED SCREW 6.5X45MM,2004669,CDM,270,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.45,
TI CANNULATED SCREW 6.5X50MM,2004670,CDM,270,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.45,
TI CANNULATED SCREW 6.5X55MM,2004671,CDM,270,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.45,
TI CANNULATED SCREW 6.5X60MM,2004672,CDM,270,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.45,
TI CANNULATED SCREW 6.5X65MM,2004673,CDM,270,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.45,
TI CANNULATED SCREW 6.5X70MM,2004674,CDM,270,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.45,
TI CANNULATED SCREW 6.5X75MM,2004675,CDM,270,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.45,
TI CANNULATED SCREW 6.5X80MM,2004676,CDM,270,RC,,,outpatient,,,938.75,469.38,,910.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,563.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,281.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,844.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,844.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,563.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,683.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,640.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,563.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,757.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,757.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,831.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,622.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,760.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,863.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,891.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,910.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,610.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,563.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,563.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,563.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,844.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,563.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,563.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,844.88,
TI CANNULATED SCREW 6.5X85MM,2004677,CDM,270,RC,,,outpatient,,,947.75,473.88,,919.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,568.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,284.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,852.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,852.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,568.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,689.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,646.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,568.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,765.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,765.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,839.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,628.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,767.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,871.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,900.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,919.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,616.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,568.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,568.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,568.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,852.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,568.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,568.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,852.98,
TI CANNULATED SCREW 6.5X90MM,2004678,CDM,270,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.45,
TI CANNULATED SCREW 6.5X95MM,2004679,CDM,270,RC,,,outpatient,,,954.5,477.25,,925.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,572.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,286.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,859.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,859.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,572.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,694.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,651.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,572.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,770.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,770.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,845.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,632.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,773.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,878.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,906.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,925.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,620.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,572.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,572.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,572.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,859.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,572.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,572.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,859.05,
TI CANNULATED SCREW 6.5X100MM,2004680,CDM,270,RC,,,outpatient,,,945.25,472.63,,916.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,283.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,850.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,850.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,687.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,645.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,763.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,763.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,837.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,626.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,765.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,869.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,897.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,916.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,614.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,850.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,850.73,
TI CANNULATED SCREW 6.5X105MM,2004681,CDM,270,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.45,
TI CANNULATED SCREW 6.5X110MM,2004682,CDM,270,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.45,
TI CANNULATED SCREW 6.5X115MM,2004683,CDM,270,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.45,
TI CANNULATED SCREW 6.5X120MM,2004684,CDM,270,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.45,
TI CANNULATED SCREW 6.5X55MM,2004685,CDM,270,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.45,
TI CANNULATED SCREW 6.5X60MM,2004686,CDM,270,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.45,
TI CANNULATED SCREW 6.5X65MM,2004687,CDM,270,RC,,,outpatient,,,1201,600.5,,1164.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,720.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,360.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,1080.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,1080.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,720.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,873.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,819.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,720.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,969.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,969.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1064.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,796.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,972.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1104.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,1140.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,1164.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,780.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,720.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,720.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,720.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1080.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,720.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,720.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1080.9,
TI CANNULATED SCREW 6.5X70MM,2004688,CDM,270,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.45,
TI CANNULATED SCREW 6.5X75MM,2004689,CDM,270,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.45,
TI CANNULATED SCREW 6.5X80MM,2004690,CDM,270,RC,,,outpatient,,,1201,600.5,,1164.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,720.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,360.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,1080.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,1080.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,720.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,873.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,819.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,720.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,969.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,969.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1064.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,796.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,972.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1104.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,1140.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,1164.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,780.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,720.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,720.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,720.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1080.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,720.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,720.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1080.9,
TI CANNULATED SCREW 6.5X85MM,2004691,CDM,270,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.45,
TI CANNULATED SCREW 6.5X90MM,2004692,CDM,270,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.45,
TI CANNULATED SCREW 6.5X95MM,2004693,CDM,270,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.45,
TI CANNULATED SCREW 6.5X100MM,2004694,CDM,270,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.45,
TI CANNULATED SCREW 6.5X105MM,2004695,CDM,270,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.45,
TI CANNULATED SCREW 6.5X110MM,2004696,CDM,270,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.45,
TI CANNULATED SCREW 6.5X115MM,2004697,CDM,270,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.45,
TI CANNULATED SCREW 6.5X120MM,2004698,CDM,270,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.45,
TI CANNULATED SCREW 8.0x40MM,2004699,CDM,270,RC,,,outpatient,,,122.75,61.38,,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,99.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,110.48,
TI CANNULATED SCREW 8.0x45MM,2004700,CDM,270,RC,,,outpatient,,,122.75,61.38,,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,99.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,110.48,
TI CANNULATED SCREW 8.0x50MM,2004701,CDM,270,RC,,,outpatient,,,122.75,61.38,,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,99.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,110.48,
TI CANNULATED SCREW 8.0x55MM,2004702,CDM,270,RC,,,outpatient,,,122.75,61.38,,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,99.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,110.48,
TI CANNULATED SCREW 8.0x60MM,2004703,CDM,270,RC,,,outpatient,,,122.75,61.38,,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,99.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,110.48,
TI CANNULATED SCREW 8.0x65MM,2004704,CDM,270,RC,,,outpatient,,,122.75,61.38,,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,99.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,110.48,
TI CANNULATED SCREW 8.0x70MM,2004705,CDM,270,RC,,,outpatient,,,122.75,61.38,,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,99.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,110.48,
TI CANNULATED SCREW 8.0x75MM,2004706,CDM,270,RC,,,outpatient,,,122.75,61.38,,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,99.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,110.48,
TI CANNULATED SCREW 8.0x80MM,2004707,CDM,270,RC,,,outpatient,,,122.75,61.38,,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,99.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,110.48,
TI CANNULATED SCREW 8.0x85MM,2004708,CDM,270,RC,,,outpatient,,,122.75,61.38,,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,99.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,110.48,
TI CANNULATED SCREW 8.0x90MM,2004709,CDM,270,RC,,,outpatient,,,122.75,61.38,,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,99.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,110.48,
TI CANNULATED SCREW 8.0x95MM,2004710,CDM,270,RC,,,outpatient,,,122.75,61.38,,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,99.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,110.48,
TI CANNULATED SCREW 8.0x100MM,2004711,CDM,270,RC,,,outpatient,,,122.75,61.38,,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,99.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,110.48,
TI CANNULATED SCREW 8.0x105MM,2004712,CDM,270,RC,,,outpatient,,,122.75,61.38,,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,99.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,110.48,
TI CANNULATED SCREW 8.0x110MM,2004713,CDM,270,RC,,,outpatient,,,122.75,61.38,,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,99.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,110.48,
TI CANNULATED SCREW 8.0x115MM,2004714,CDM,270,RC,,,outpatient,,,122.75,61.38,,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,99.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,110.48,
TI CANNULATED SCREW 8.0x120MM,2004715,CDM,270,RC,,,outpatient,,,122.75,61.38,,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,99.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,110.48,
GAMMA GUIDE PIN 4X400MM STERILE,2004716,CDM,270,RC,,,outpatient,,,116,58,,112.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,104.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,104.4,
DRILL 4.2X230MM AO/STERILE,2004717,CDM,270,RC,,,outpatient,,,171.75,85.88,,166.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,154.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,154.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,117.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,138.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,113.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,139.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,158.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,163.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,166.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,154.58,
GAMMA 3 IL RT/10X320MMX125,2004718,CDM,270,RC,,,outpatient,,,1028.75,514.38,,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,748.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,702.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,911.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,682.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,833.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,946.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,977.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,668.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,925.88,
GAMMA 3 IL RT/10X340MMX125,2004719,CDM,270,RC,,,outpatient,,,1028.75,514.38,,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,748.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,702.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,911.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,682.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,833.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,946.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,977.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,668.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,925.88,
GAMMA 3 IL RT/10X360MMX125,2004720,CDM,270,RC,,,outpatient,,,1028.75,514.38,,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,748.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,702.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,911.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,682.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,833.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,946.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,977.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,668.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,925.88,
GAMMA 3 IL RT/10X380MMX125,2004721,CDM,270,RC,,,outpatient,,,1028.75,514.38,,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,748.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,702.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,911.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,682.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,833.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,946.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,977.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,668.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,925.88,
GAMMA 3 IL RT/10X400MMX125,2004722,CDM,270,RC,,,outpatient,,,1028.75,514.38,,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,748.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,702.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,911.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,682.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,833.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,946.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,977.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,668.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,925.88,
GAMMA 3 IL RT/10X420MMX125,2004723,CDM,270,RC,,,outpatient,,,1028.75,514.38,,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,748.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,702.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,911.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,682.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,833.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,946.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,977.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,668.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,925.88,
GAMMA 3 IL RT/10X320MMX125,2004724,CDM,270,RC,,,outpatient,,,1028.75,514.38,,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,748.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,702.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,911.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,682.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,833.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,946.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,977.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,668.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,925.88,
GAMMA 3 IL RT/10X340MMX125,2004725,CDM,270,RC,,,outpatient,,,1028.75,514.38,,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,748.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,702.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,911.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,682.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,833.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,946.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,977.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,668.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,925.88,
GAMMA 3 IL RT/10X360MMX125,2004726,CDM,270,RC,,,outpatient,,,1028.75,514.38,,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,748.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,702.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,911.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,682.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,833.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,946.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,977.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,668.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,925.88,
GAMMA 3 IL RT/10X380MMX125,2004727,CDM,270,RC,,,outpatient,,,1028.75,514.38,,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,748.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,702.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,911.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,682.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,833.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,946.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,977.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,668.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,925.88,
GAMMA 3 IL RT/10X400MMX125,2004728,CDM,270,RC,,,outpatient,,,1028.75,514.38,,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,748.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,702.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,911.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,682.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,833.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,946.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,977.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,668.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,925.88,
GAMMA 3 IL RT/10X420MMX125,2004729,CDM,270,RC,,,outpatient,,,1028.75,514.38,,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,748.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,702.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,911.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,682.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,833.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,946.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,977.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,668.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,925.88,
GAMMA 3 IL RT/10X260MMX125,2004730,CDM,270,RC,,,outpatient,,,1028.75,514.38,,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,748.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,702.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,911.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,682.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,833.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,946.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,977.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,668.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,925.88,
GAMMA 3 IL RT/10X280MMX125,2004731,CDM,270,RC,,,outpatient,,,1028.75,514.38,,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,748.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,702.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,911.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,682.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,833.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,946.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,977.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,668.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,925.88,
GAMMA 3 IL RT/10X300MMX125,2004732,CDM,270,RC,,,outpatient,,,1028.75,514.38,,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,748.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,702.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,911.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,682.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,833.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,946.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,977.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,668.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,925.88,
GAMMA 3 IL RT/10X440MMX125,2004733,CDM,270,RC,,,outpatient,,,1028.75,514.38,,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,748.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,702.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,911.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,682.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,833.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,946.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,977.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,668.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,925.88,
GAMMA 3 IL RT/10X460MMX125,2004734,CDM,270,RC,,,outpatient,,,1028.75,514.38,,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,748.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,702.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,911.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,682.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,833.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,946.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,977.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,668.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,925.88,
GAMMA 3 IL RT/10X260MMX125,2004735,CDM,270,RC,,,outpatient,,,1028.75,514.38,,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,748.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,702.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,911.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,682.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,833.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,946.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,977.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,668.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,925.88,
GAMMA 3 IL RT/10X280MMX125,2004736,CDM,270,RC,,,outpatient,,,1028.75,514.38,,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,748.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,702.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,911.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,682.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,833.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,946.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,977.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,668.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,925.88,
GAMMA 3 IL RT/10X300MMX125,2004737,CDM,270,RC,,,outpatient,,,1028.75,514.38,,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,748.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,702.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,911.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,682.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,833.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,946.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,977.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,668.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,925.88,
GAMMA 3 IL RT/10X440MMX125,2004738,CDM,270,RC,,,outpatient,,,1028.75,514.38,,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,748.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,702.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,911.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,682.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,833.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,946.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,977.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,668.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,925.88,
GAMMA 3 IL RT/10X460MMX125,2004739,CDM,270,RC,,,outpatient,,,1028.75,514.38,,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,748.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,702.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,830.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,911.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,682.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,833.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,946.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,977.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,997.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,668.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,925.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,617.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,925.88,
K WIRE 3.2X450MMSTERILE,2004740,CDM,270,RC,,,outpatient,,,116,58,,112.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,104.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,104.4,
GAMMA CLOSE TUBE CLIP,2004741,CDM,270,RC,,,outpatient,,,333.25,166.63,,323.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,199.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,299.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,299.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,199.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,227.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,199.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,269,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,295.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,220.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,269.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,306.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,316.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,323.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,216.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,199.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,199.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,199.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,299.93,
DRILL 4.2X300MM AO SMALLSTERILE,2004742,CDM,270,RC,,,outpatient,,,410.25,205.13,,397.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,246.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,369.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,369.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,246.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,298.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,280,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,246.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,331.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,331.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,363.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,272,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,332.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,377.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,389.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,397.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,266.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,246.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,246.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,246.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,369.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,246.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,246.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,369.23,
DRILL 4.2X180MM AO SMALLSTERILE,2004743,CDM,270,RC,,,outpatient,,,404,202,,391.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,242.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,363.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,363.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,242.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,293.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,275.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,242.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,326.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,326.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,357.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,267.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,327.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,371.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,383.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,391.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,262.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,242.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,363.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,242.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,242.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,363.6,
TI SET SCREW8X17.5MM,2004744,CDM,270,RC,,,outpatient,,,176,88,,170.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,116.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,142.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,161.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,170.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,158.4,
TI  END CAP STANDARD 0MM,2004745,CDM,270,RC,,,outpatient,,,176,88,,170.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,116.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,142.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,161.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,170.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,158.4,
TI  END CAP 5MM+5,2004746,CDM,270,RC,,,outpatient,,,1912,956,,1854.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,1147.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,573.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,1720.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1720.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1147.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1391.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1304.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1147.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1543.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1543.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1694.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1267.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1548.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1759.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,1816.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,1854.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,1242.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,1147.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1147.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1147.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1720.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1147.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1147.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1720.8,
TI  LAG SCREW10.5X75MM,2004747,CDM,278,RC,,,outpatient,,,1912,956,,1854.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,1147.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,573.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,1720.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1720.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1147.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1391.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1304.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1147.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1543.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1543.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1694.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1267.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1548.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1759.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,1816.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,1854.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,1242.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,1147.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1147.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1147.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1720.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1147.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1147.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1720.8,
TI  LAG SCREW10.5X80MM,2004748,CDM,270,RC,,,outpatient,,,1912,956,,1854.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,1147.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,573.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,1720.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1720.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1147.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1391.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1304.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1147.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1543.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1543.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1694.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1267.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1548.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1759.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,1816.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,1854.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,1242.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,1147.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1147.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1147.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1720.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1147.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1147.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1720.8,
TI  LAG SCREW10.5X85MM,2004749,CDM,270,RC,,,outpatient,,,1024.25,512.13,,993.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,614.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,307.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,921.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,921.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,614.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,745.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,699.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,614.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,826.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,826.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,907.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,679.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,829.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,942.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,973.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,993.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,665.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,614.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,614.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,614.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,921.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,614.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,614.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,921.83,
TI  LAG SCREW10.5X90MM,2004750,CDM,270,RC,,,outpatient,,,1060,530,,1028.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,636,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,318,30,,,percent of total billed charges,Pays at 30% of total billed charges,954,90,,,percent of total billed charges,Pays at 90% of total billed charges,954,90,,,percent of total billed charges,Pays at 90% of total billed charges,636,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,771.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,723.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,636,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,855.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,855.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,939.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,702.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,858.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,975.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,1007,95,,,percent of total billed charges,Pays at 95% of total billed charges,1028.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,689,65,,,percent of total billed charges,Pays at 65% of total billed charges,636,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,636,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,636,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,954,90,,,percent of total billed charges,Pays at 90% of total billed charges,636,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,636,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,954,
TI  LAG SCREW10.5X95MM,2004751,CDM,278,RC,,,outpatient,,,1060.25,530.13,,1028.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,636.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,954.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,954.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,636.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,771.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,723.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,636.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,855.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,855.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,939.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,702.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,858.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,975.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,1007.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,1028.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,689.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,636.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,636.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,636.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,954.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,636.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,636.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,954.23,
TI  LAG SCREW10.5X100MM,2004752,CDM,270,RC,,,outpatient,,,245,122.5,,237.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,220.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,220.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,167.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,197.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,217.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,162.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,198.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,225.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,232.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,237.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,159.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,220.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,220.5,
TI  LAG SCREW10.5X105MM,2004753,CDM,270,RC,,,outpatient,,,245,122.5,,237.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,220.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,220.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,167.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,197.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,217.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,162.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,198.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,225.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,232.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,237.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,159.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,220.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,220.5,
TI  LAG SCREW10.5X110MM,2004754,CDM,270,RC,,,outpatient,,,245,122.5,,237.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,220.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,220.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,167.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,197.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,217.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,162.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,198.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,225.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,232.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,237.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,159.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,220.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,220.5,
TI  LAG SCREW10.5X115MM,2004755,CDM,270,RC,,,outpatient,,,245,122.5,,237.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,220.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,220.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,167.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,197.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,217.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,162.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,198.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,225.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,232.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,237.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,159.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,220.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,220.5,
TI  LAG SCREW10.5X120MM,2004756,CDM,270,RC,,,outpatient,,,245,122.5,,237.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,220.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,220.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,167.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,197.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,217.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,162.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,198.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,225.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,232.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,237.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,159.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,220.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,220.5,
GAMMA 3 TI LAG SCREW 10.5X70MM,2004757,CDM,270,RC,,,outpatient,,,211.5,105.75,,205.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,126.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,190.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,190.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,126.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,153.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,144.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,126.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,170.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,187.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,140.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,171.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,194.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,200.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,205.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,137.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,126.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,126.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,126.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,190.35,
TI END CAP10MM+10,2004758,CDM,270,RC,,,outpatient,,,132,66,,128.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,118.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,90.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,106.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,121.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,125.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,128.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,118.8,
GUIDE WIRE BALL TIP 3.0X800MM STERILE,2004759,CDM,270,RC,,,outpatient,,,397.25,198.63,,385.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,238.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,357.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,357.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,238.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,289.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,271.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,238.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,320.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,352,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,263.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,321.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,365.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,377.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,385.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,258.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,238.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,357.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,238.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,238.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,357.53,
GUIDE WIRE BALL TIP 3.0X1000MM STERILE,2004760,CDM,270,RC,,,outpatient,,,176,88,,170.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,116.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,142.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,161.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,170.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,158.4,
U BLADE LAG SCREW SET TITANIUM 10.5X75,2004761,CDM,270,RC,,,outpatient,,,356,178,,345.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,242.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,315.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,236.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,288.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,327.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,338.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,345.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,231.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,320.4,
U BLADE LAG SCREW SET TITANIUM 10.5X80,2004762,CDM,270,RC,,,outpatient,,,356,178,,345.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,242.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,315.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,236.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,288.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,327.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,338.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,345.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,231.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,320.4,
U BLADE LAG SCREW SET TITANIUM 10.5X85,2004763,CDM,270,RC,,,outpatient,,,356,178,,345.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,242.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,315.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,236.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,288.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,327.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,338.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,345.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,231.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,320.4,
U BLADE LAG SCREW SET TITANIUM 10.5X90,2004764,CDM,270,RC,,,outpatient,,,356,178,,345.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,242.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,315.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,236.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,288.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,327.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,338.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,345.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,231.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,320.4,
U BLADE LAG SCREW SET TITANIUM 10.5X95,2004765,CDM,270,RC,,,outpatient,,,356,178,,345.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,242.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,315.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,236.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,288.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,327.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,338.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,345.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,231.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,320.4,
U BLADE LAG SCREW SET TITANIUM 10.5X100,2004766,CDM,270,RC,,,outpatient,,,356,178,,345.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,242.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,315.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,236.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,288.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,327.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,338.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,345.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,231.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,320.4,
U BLADE LAG SCREW SET TITANIUM 10.5X105,2004767,CDM,270,RC,,,outpatient,,,356,178,,345.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,242.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,315.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,236.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,288.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,327.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,338.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,345.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,231.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,320.4,
U BLADE LAG SCREW SET TITANIUM 10.5X110,2004768,CDM,270,RC,,,outpatient,,,356,178,,345.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,242.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,315.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,236.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,288.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,327.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,338.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,345.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,231.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,320.4,
U BLADE LAG SCREW SET TITANIUM 10.5X115,2004769,CDM,270,RC,,,outpatient,,,356,178,,345.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,242.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,315.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,236.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,288.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,327.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,338.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,345.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,231.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,320.4,
U BLADE LAG SCREW SET TITANIUM 10.5X120,2004770,CDM,270,RC,,,outpatient,,,356,178,,345.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,242.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,315.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,236.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,288.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,327.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,338.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,345.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,231.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,320.4,
U BLADE LAG SCREW SET TITANIUM 10.5X70,2004771,CDM,270,RC,,,outpatient,,,356,178,,345.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,242.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,315.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,236.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,288.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,327.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,338.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,345.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,231.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,320.4,
U BLADE LAG SCREW SET TITANIUM 10.5X125,2004772,CDM,270,RC,,,outpatient,,,356,178,,345.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,242.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,315.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,236.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,288.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,327.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,338.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,345.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,231.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,320.4,
U BLADE LAG SCREW SET TITANIUM 10.5X125,2004773,CDM,270,RC,,,outpatient,,,356,178,,345.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,242.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,315.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,236.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,288.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,327.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,338.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,345.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,231.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,320.4,
LOCKING SCREW T2 F/T 5MMX25MM,2004774,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
LOCKING SCREW T2 F/T 5MMX27.5MM,2004775,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
LOCKING SCREW T2 F/T 5MMX30MM,2004776,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
LOCKING SCREW T2 F/T 5MMX32.5MM,2004777,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
LOCKING SCREW T2 F/T 5MMX35MM,2004778,CDM,270,RC,,,outpatient,,,361.75,180.88,,350.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,217.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,325.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,325.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,217.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,263.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,246.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,217.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,292,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,292,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,320.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,239.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,293.02,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,332.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,343.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,350.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,235.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,217.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,217.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,217.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,325.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,217.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,217.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,325.58,
LOCKING SCREW T2 F/T 5MMX37.5MM,2004779,CDM,270,RC,,,outpatient,,,361.75,180.88,,350.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,217.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,325.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,325.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,217.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,263.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,246.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,217.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,292,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,292,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,320.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,239.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,293.02,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,332.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,343.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,350.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,235.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,217.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,217.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,217.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,325.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,217.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,217.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,325.58,
LOCKING SCREW T2 F/T 5MMX40MM,2004780,CDM,270,RC,,,outpatient,,,349.5,174.75,,339.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,314.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,314.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,238.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,282.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,282.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,309.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,231.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,283.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,321.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,332.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,339.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,227.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,314.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,209.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,314.55,
LOCKING SCREW T2 F/T 5MMX42.5MM,2004781,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
LOCKING SCREW T2 F/T 5MMX45MM,2004782,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
LOCKING SCREW T2 F/T 5MMX47.5MM,2004783,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
LOCKING SCREW T2 F/T 5MMX50MM,2004784,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
LOCKING SCREW T2 F/T 5MMX52.5MM,2004785,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
LOCKING SCREW T2 F/T 5MMX55MM,2004786,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
LOCKING SCREW T2 F/T 5MMX57.5MM,2004787,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
LOCKING SCREW T2 F/T 5MMX60MM,2004788,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
LOCKING SCREW T2 F/T 5MMX65MM,2004789,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
LOCKING SCREW T2 F/T 5MMX70MM,2004790,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
LOCKING SCREW T2 F/T 5MMX75MM,2004791,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
LOCKING SCREW T2 F/T 5MMX80MM,2004792,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
LOCKING SCREW T2 F/T 5MMX85MM,2004793,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
LOCKING SCREW T2 F/T 5MMX90MM,2004794,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
LOCKING SCREW T2 F/T 5MMX95MM,2004795,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
LOCKING SCREW T2 F/T 5MMX100MM,2004796,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
LOCKING SCREW T2 F/T 5MMX105MM,2004797,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
LOCKING SCREW T2 F/T 5MMX110MM,2004798,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
LOCKING SCREW T2 F/T 5MMX115MM,2004799,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
LOCKING SCREW T2 F/T 5MMX120MM,2004800,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
SHAFT SCREW T2  5MMX25MM,2004801,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
SHAFT SCREW T2  5MMX30MM,2004802,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
SHAFT SCREW T2  5MMX35MM,2004803,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
SHAFT SCREW T2  5MMX40MM,2004804,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
SHAFT SCREW T2  5MMX45MM,2004805,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
SHAFT SCREW T2  5MMX50MM,2004806,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
SHAFT SCREW T2  5MMX55MM,2004807,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
SHAFT SCREW T2  5MMX60MM,2004808,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
SHAFT SCREW T2  5MMX65MM,2004809,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
SHAFT SCREW T2  5MMX70MM,2004810,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
SHAFT SCREW T2  5MMX75MM,2004811,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
SHAFT SCREW T2  5MMX80MM,2004812,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
SHAFT SCREW T2  5MMX85MM,2004813,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
SHAFT SCREW T2  5MMX90MM,2004814,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
SHAFT SCREW T2  5MMX95MM,2004815,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
SHAFT SCREW T2  5MMX100MM,2004816,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
SHAFT SCREW T2  5MMX105MM,2004817,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
SHAFT SCREW T2  5MMX110MM,2004818,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
SHAFT SCREW T2  5MMX115MM,2004819,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
SHAFT SCREW T2  5MMX120MM,2004820,CDM,270,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
D/M 1.6MM SS CABLE,2004821,CDM,270,RC,,,outpatient,,,150,75,,145.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45,30,,,percent of total billed charges,Pays at 30% of total billed charges,135,90,,,percent of total billed charges,Pays at 90% of total billed charges,135,90,,,percent of total billed charges,Pays at 90% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,90,,,percent of total billed charges,Pays at 90% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135,
D/M 2.0MM SS CABLE,2004822,CDM,270,RC,,,outpatient,,,150,75,,145.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45,30,,,percent of total billed charges,Pays at 30% of total billed charges,135,90,,,percent of total billed charges,Pays at 90% of total billed charges,135,90,,,percent of total billed charges,Pays at 90% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,90,,,percent of total billed charges,Pays at 90% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135,
D/M 1.6MM SS BEADED CABLE/SLEEVE SET,2004823,CDM,270,RC,,,outpatient,,,150,75,,145.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45,30,,,percent of total billed charges,Pays at 30% of total billed charges,135,90,,,percent of total billed charges,Pays at 90% of total billed charges,135,90,,,percent of total billed charges,Pays at 90% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,90,,,percent of total billed charges,Pays at 90% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135,
D/M 2.0MM SS BEADED CABLE/SLEEVE SET,2004824,CDM,270,RC,,,outpatient,,,150,75,,145.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45,30,,,percent of total billed charges,Pays at 30% of total billed charges,135,90,,,percent of total billed charges,Pays at 90% of total billed charges,135,90,,,percent of total billed charges,Pays at 90% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,90,,,percent of total billed charges,Pays at 90% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135,
D/M 6.5MM SS BROAD COP PLATE,2004825,CDM,270,RC,,,outpatient,,,235.75,117.88,,228.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,212.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,212.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,160.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,190.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,156.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,190.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,216.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,223.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,228.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,153.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,212.18,
D/M 8.0MM SS BROAD COP PLATE,2004826,CDM,270,RC,,,outpatient,,,235.75,117.88,,228.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,212.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,212.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,160.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,190.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,156.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,190.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,216.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,223.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,228.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,153.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,212.18,
D/M 10MM SS BROAD COP PLATE,2004827,CDM,270,RC,,,outpatient,,,235.75,117.88,,228.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,212.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,212.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,160.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,190.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,156.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,190.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,216.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,223.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,228.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,153.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,212.18,
D/M 12MM SS BROAD COP PLATE,2004828,CDM,270,RC,,,outpatient,,,235.75,117.88,,228.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,212.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,212.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,160.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,190.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,156.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,190.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,216.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,223.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,228.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,153.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,212.18,
D/M 1.6MM SS CABLE SLEEVE,2004829,CDM,270,RC,,,outpatient,,,150,75,,145.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45,30,,,percent of total billed charges,Pays at 30% of total billed charges,135,90,,,percent of total billed charges,Pays at 90% of total billed charges,135,90,,,percent of total billed charges,Pays at 90% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,90,,,percent of total billed charges,Pays at 90% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135,
D/M 2.0MM SS CABLE SLEEVE,2004830,CDM,270,RC,,,outpatient,,,150,75,,145.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45,30,,,percent of total billed charges,Pays at 30% of total billed charges,135,90,,,percent of total billed charges,Pays at 90% of total billed charges,135,90,,,percent of total billed charges,Pays at 90% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,90,,,percent of total billed charges,Pays at 90% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135,
DALL MILES SM/STAINLESS ST GRIP,2004831,CDM,270,RC,,,outpatient,,,460.5,230.25,,446.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,414.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,414.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,335.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,314.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,371.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,371.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,408.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,305.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,373.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,423.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,437.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,446.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,299.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,414.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,414.45,
DALL MILES MD/STAINLESS ST GRIP,2004832,CDM,270,RC,,,outpatient,,,460.5,230.25,,446.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,414.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,414.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,335.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,314.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,371.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,371.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,408.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,305.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,373.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,423.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,437.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,446.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,299.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,414.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,414.45,
DALL MILES MD/STAINLESS ST GRIPPLATE 100,2004833,CDM,270,RC,,,outpatient,,,567.25,283.63,,550.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,340.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,510.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,510.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,340.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,412.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,387.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,340.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,457.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,457.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,502.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,376.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,459.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,521.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,538.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,550.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,368.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,340.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,340.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,340.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,510.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,340.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,340.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,510.53,
DALL MILES MD/STAINLESS ST GRIPPLATE 150,2004834,CDM,270,RC,,,outpatient,,,743.75,371.88,,721.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,446.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,669.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,669.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,446.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,541.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,507.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,446.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,600.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,659.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,493.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,602.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,684.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,706.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,721.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,483.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,446.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,446.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,446.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,669.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,446.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,446.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,669.38,
DALL MILES MD/STAINLESS ST GRIPPLATE 200,2004835,CDM,270,RC,,,outpatient,,,921.75,460.88,,894.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,553.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,276.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,829.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,829.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,553.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,670.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,629.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,553.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,744.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,744.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,816.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,611.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,746.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,848.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,875.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,894.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,599.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,553.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,553.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,553.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,829.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,553.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,553.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,829.58,
DALL MILES LG/STAINLESS ST GRIP,2004836,CDM,270,RC,,,outpatient,,,460.5,230.25,,446.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,414.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,414.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,335.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,314.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,371.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,371.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,408.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,305.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,373.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,423.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,437.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,446.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,299.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,414.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,276.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,414.45,
DALL MILES LG/STAINLESS ST GRIPPLATE 110,2004837,CDM,270,RC,,,outpatient,,,567.25,283.63,,550.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,340.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,510.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,510.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,340.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,412.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,387.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,340.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,457.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,457.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,502.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,376.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,459.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,521.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,538.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,550.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,368.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,340.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,340.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,340.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,510.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,340.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,340.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,510.53,
DALL MILES LG/STAINLESS ST GRIPPLATE 160,2004838,CDM,270,RC,,,outpatient,,,743.75,371.88,,721.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,446.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,669.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,669.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,446.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,541.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,507.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,446.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,600.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,659.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,493.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,602.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,684.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,706.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,721.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,483.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,446.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,446.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,446.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,669.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,446.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,446.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,669.38,
DALL MILES LG/STAINLESS ST GRIPPLATE 210,2004839,CDM,270,RC,,,outpatient,,,873.75,436.88,,847.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,524.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,786.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,786.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,524.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,635.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,596.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,524.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,705.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,705.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,774.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,579.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,707.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,803.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,830.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,847.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,567.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,524.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,524.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,524.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,786.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,524.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,524.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,786.38,
GRAY TIP DRILL 1/8.125X5'',2004840,CDM,270,RC,,,outpatient,,,107.75,53.88,,104.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,96.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,95.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,71.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,87.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,99.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,102.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,104.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,96.98,
OMEGA PLUS 3.2MMX125MM GRAY BI DR ONE DR,2004841,CDM,270,RC,,,outpatient,,,104.5,52.25,,101.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,94.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,71.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,69.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,84.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,96.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,99.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,101.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,62.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,94.05,
SELF TAP CORTICAL SCREW 4.5X14MM,2004842,CDM,270,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
SELF TAP CORTICAL SCREW 4.5X16MM,2004843,CDM,270,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
SELF TAP CORTICAL SCREW 4.5X18MM,2004844,CDM,270,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
SELF TAP CORTICAL SCREW 4.5X20MM,2004845,CDM,270,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
SELF TAP CORTICAL SCREW 4.5X22MM,2004846,CDM,270,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
SELF TAP CORTICAL SCREW 4.5X24MM,2004847,CDM,270,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
SELF TAP CORTICAL SCREW 4.5X26MM,2004848,CDM,270,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
SELF TAP CORTICAL SCREW 4.5X28MM,2004849,CDM,270,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
SELF TAP CORTICAL SCREW 4.5X30MM,2004850,CDM,270,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
SELF TAP CORTICAL SCREW 4.5X32MM,2004851,CDM,270,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
SELF TAP CORTICAL SCREW 4.5X34MM,2004852,CDM,270,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
SELF TAP CORTICAL SCREW 4.5X36MM,2004853,CDM,270,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
SELF TAP CORTICAL SCREW 4.5X38MM,2004854,CDM,270,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
SELF TAP CORTICAL SCREW 4.5X40MM,2004855,CDM,270,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
SELF TAP CORTICAL SCREW 4.5X42MM,2004856,CDM,270,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
SELF TAP CORTICAL SCREW 4.5X44MM,2004857,CDM,270,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
SELF TAP CORTICAL SCREW 4.5X46MM,2004858,CDM,270,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
SELF TAP CORTICAL SCREW 4.5X48MM,2004859,CDM,270,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
SELF TAP CORTICAL SCREW 4.5X50MM,2004860,CDM,270,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
SELF TAP CORTICAL SCREW 4.5X52MM,2004861,CDM,270,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
SELF TAP CORTICAL SCREW 4.5X54MM,2004862,CDM,270,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
SELF TAP CORTICAL SCREW 4.5X56MM,2004863,CDM,270,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
SELF TAP CORTICAL SCREW 4.5X58MM,2004864,CDM,270,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
SELF TAP CORTICAL SCREW 4.5X60MM,2004865,CDM,270,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
SELF TAP CORTICAL SCREW 4.5X62MM,2004866,CDM,270,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
SELF TAP CORTICAL SCREW 4.5X64MM,2004867,CDM,270,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
SELF TAP CORTICAL SCREW 4.5X66MM,2004868,CDM,270,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
SELF TAP CORTICAL SCREW 4.5X68MM,2004869,CDM,270,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
SELF TAP CORTICAL SCREW 4.5X70MM,2004870,CDM,270,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
REDUCTION PIN4.5MM DIA .150MM,2004871,CDM,270,RC,,,outpatient,,,150.25,75.13,,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135.23,
K WIRE 1.6X150MM SS,2004872,CDM,270,RC,,,outpatient,,,18.75,9.38,,18.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,90,
K WIRETROCAR POINT,2004873,CDM,270,RC,,,outpatient,,,8.5,4.25,,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,90,
TWIST DRILL 3.5MM/195MM AO FIT,2004874,CDM,270,RC,,,outpatient,,,174.75,87.38,,169.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,157.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,119.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,115.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,141.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,160.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,166.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,169.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,157.28,
TWIST DRILL 4.5MM/65MM  FIT,2004875,CDM,270,RC,,,outpatient,,,174.75,87.38,,169.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,157.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,119.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,115.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,141.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,160.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,166.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,169.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,157.28,
DRILL BIT 3.2MM/L180MM AO/ CALIB,2004876,CDM,270,RC,,,outpatient,,,174.75,87.38,,169.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,157.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,119.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,115.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,141.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,160.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,166.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,169.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,157.28,
DRILL BIT 3.2MM/L145MM AO,2004877,CDM,270,RC,,,outpatient,,,150.75,75.38,,146.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,135.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,122.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,143.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,146.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135.68,
TAP 3.5MM /L-180MM/AO/FIT,2004878,CDM,270,RC,,,outpatient,,,204,102,,197.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,122.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,183.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,183.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,122.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,139.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,122.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,164.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,180.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,135.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,165.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,187.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,193.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,197.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,132.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,122.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,122.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,122.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,183.6,
TAP 4.5MM /L-180MM/AO/FIT,2004879,CDM,270,RC,,,outpatient,,,232.25,116.13,,225.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,209.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,158.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,187.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,205.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,153.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,188.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,213.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,220.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,225.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,150.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,209.03,
SCREW LOCKING T10 3.5X14MM,2004880,CDM,270,RC,,,outpatient,,,572,286,,554.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,343.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,514.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,514.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,343.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,416.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,390.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,343.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,461.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,461.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,506.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,379.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,463.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,526.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,543.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,554.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,371.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,343.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,343.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,343.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,514.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,343.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,343.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,514.8,
SCREW BONE T10 3.5X14MM,2004881,CDM,278,RC,,,outpatient,,,295,147.5,,286.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,177,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,265.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,265.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,177,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,201.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,177,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,238.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,261.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,195.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,238.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,271.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,280.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,286.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,191.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,177,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,265.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,177,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,177,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,265.5,
SCREW BONE T10 3.5X16MM,2004882,CDM,278,RC,,,outpatient,,,295,147.5,,286.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,177,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,265.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,265.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,177,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,201.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,177,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,238.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,261.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,195.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,238.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,271.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,280.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,286.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,191.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,177,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,265.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,177,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,177,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,265.5,
PLATE SUPERIOR DECREASED,2004883,CDM,270,RC,,,outpatient,,,3449.25,1724.63,,3345.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,2069.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1034.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,3104.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,3104.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,2069.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2509.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2354.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2069.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2784.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2784.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3056.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2286.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2793.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3173.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,3276.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,3345.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,2242.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,2069.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2069.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2069.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3104.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,2069.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2069.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3104.33,
DRILL 2.6MMX122MM,2004884,CDM,270,RC,,,outpatient,,,509.5,254.75,,494.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,458.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,458.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,347.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,411.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,411.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,451.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,337.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,412.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,468.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,484.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,494.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,331.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,458.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,458.55,
SCREWDRIVER BLADE AO T-10,2004885,CDM,270,RC,,,outpatient,,,995.75,497.88,,965.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,597.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,298.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,896.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,896.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,597.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,724.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,679.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,597.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,803.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,803.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,882.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,660.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,806.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,916.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,945.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,965.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,647.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,597.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,597.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,597.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,896.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,597.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,597.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,896.18,
PRESSURIZER SM,2004886,CDM,270,RC,,,outpatient,,,67.75,33.88,,65.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,44.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,54.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,62.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,65.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.65,90,
PRESSURIZER MED,2004887,CDM,270,RC,,,outpatient,,,67.75,33.88,,65.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,44.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,54.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,62.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,65.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.65,90,
PRESSURIZER LG,2004888,CDM,270,RC,,,outpatient,,,67.75,33.88,,65.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,44.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,54.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,62.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,65.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.65,90,
PLATE SUPERIOR DECREASED,2004889,CDM,270,RC,,,outpatient,,,3912.25,1956.13,,3794.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2347.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1173.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,3521.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,3521.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,2347.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2846.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2670.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2347.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3157.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3157.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3466.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2593.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3168.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3599.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,3716.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,3794.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2542.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,2347.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2347.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2347.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3521.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,2347.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2347.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3521.03,
BLADE SCREW DRIOVER T10 AO,2004890,CDM,270,RC,,,outpatient,,,1155.75,577.88,,1121.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,693.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,346.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,1040.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1040.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,693.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,840.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,788.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,693.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,932.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,932.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1024.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,766.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,936.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1063.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,1097.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,1121.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,751.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,693.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,693.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,693.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1040.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,693.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,693.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1040.18,
K WIRE 3.2X450MM,2004891,CDM,270,RC,,,outpatient,,,283,141.5,,274.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,169.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,254.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,169.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,193.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,169.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,228.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,250.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,187.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,229.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,260.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,268.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,274.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,183.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,169.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,169.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,169.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,254.7,
GUIDE WIRE BALL TIP,2004892,CDM,270,RC,,,outpatient,,,667,333.5,,646.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,538.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,538.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,613.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,633.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,646.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,433.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.3,
LONG IL KIT 1/5 TI,2004894,CDM,270,RC,,,outpatient,,,8099.25,4049.63,,7856.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,4859.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2429.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,7289.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,7289.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,4859.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5893.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5527.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4859.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6537.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6537.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7176.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5369.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6560.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7451.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,7694.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,7856.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,5264.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,4859.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4859.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4859.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7289.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,4859.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4859.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,7289.33,
FIBERWIRE #1,2004895,CDM,270,RC,,,outpatient,,,100.5,50.25,,97.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,90.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,68.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,66.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,81.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,92.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,95.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,97.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,60.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,90.45,
SUTURE TAPE FIBERLINK,2004896,CDM,270,RC,,,outpatient,,,184.45,92.23,,178.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,110.67,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.34,30,,,percent of total billed charges,Pays at 30% of total billed charges,166.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.67,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,125.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,110.67,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,163.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,122.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,149.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,169.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,175.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,178.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,119.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,110.67,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.67,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.67,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.67,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,110.67,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,166.01,
SPEED BRIDGE,2004897,CDM,270,RC,,,outpatient,,,4754,2377,,4611.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,2852.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1426.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,4278.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,4278.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2852.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3459.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3244.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2852.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3837.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3837.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4212.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3151.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3850.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4373.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,4516.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,4611.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,3090.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,2852.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2852.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2852.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4278.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2852.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2852.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4278.6,
SUTURE TAPE,2004898,CDM,270,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
MICRO BLADE,2004899,CDM,270,RC,,,outpatient,,,131.25,65.63,,127.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,118.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,106.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,120.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,124.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,127.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,118.13,
BLADE SAW,2004900,CDM,270,RC,,,outpatient,,,151.75,75.88,,147.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,136.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,103.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,122.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,100.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,122.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,139.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,144.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,147.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,136.58,
BLADE SAW,2004901,CDM,270,RC,,,outpatient,,,234.75,117.38,,227.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,211.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,211.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,160.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,189.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,189.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,155.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,190.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,215.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,223.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,227.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,152.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,211.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,211.28,
NEEDLE 3/8 .037X1.365 CIRCLE,2004902,CDM,270,RC,,,outpatient,,,5.5,2.75,,5.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,90,
NEEDLE 1/2  CIRCLE POINT,2004903,CDM,270,RC,,,outpatient,,,5.5,2.75,,5.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,90,
PLATE 1/3 TUBULAR,2004904,CDM,278,RC,,,outpatient,,,1397.75,698.88,,1355.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,838.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,419.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,1257.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,1257.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,838.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1017,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,953.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,838.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1128.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1128.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1238.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,926.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1132.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1285.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,1327.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,1355.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,908.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,838.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,838.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,838.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1257.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,838.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,838.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1257.98,
SCREW BONE T-10F/T,2004905,CDM,278,RC,,,outpatient,,,336.25,168.13,,326.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,302.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,302.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,244.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,229.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,271.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,297.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,222.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,272.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,309.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,319.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,326.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,218.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,302.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,302.63,
SCREW BONE T-10F/T,2004906,CDM,278,RC,,,outpatient,,,336.25,168.13,,326.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,302.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,302.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,244.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,229.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,271.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,297.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,222.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,272.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,309.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,319.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,326.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,218.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,302.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,302.63,
DRILL BIT AO DIA 2.0MM,2004907,CDM,270,RC,,,outpatient,,,549,274.5,,532.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,494.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,494.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,399.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,374.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,443.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,443.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,486.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,363.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,444.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,505.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,521.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,532.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,356.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,494.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,494.1,
OVERDRILL AO DIA 3.5MM,2004908,CDM,270,RC,,,outpatient,,,549,274.5,,532.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,494.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,494.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,399.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,374.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,443.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,443.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,486.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,363.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,444.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,505.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,521.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,532.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,356.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,494.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,494.1,
TAP AO FOR 3.5MM SCREW,2004909,CDM,270,RC,,,outpatient,,,1076,538,,1043.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,645.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,968.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,968.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,645.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,782.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,734.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,645.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,868.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,868.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,953.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,713.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,871.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,989.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,1022.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,1043.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,699.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,645.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,645.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,645.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,968.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,645.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,645.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,968.4,
TRANSOSSEOUS,2004910,CDM,270,RC,,,outpatient,,,155,77.5,,150.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,139.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,105.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,137.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,102.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,125.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,142.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,147.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,150.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,139.5,
SYRINGE SYSTEM,2004911,CDM,270,RC,,,outpatient,,,357.5,178.75,,346.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,214.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,321.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,321.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,214.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,260.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,243.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,214.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,288.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,288.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,316.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,237.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,289.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,328.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,339.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,346.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,232.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,214.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,321.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,214.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,214.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,321.75,
BIOCOMP TENO SWIVELOCK,2004912,CDM,270,RC,,,outpatient,,,964.25,482.13,,935.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,578.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,289.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,867.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,867.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,578.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,701.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,658.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,578.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,778.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,778.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,854.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,639.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,781.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,887.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,916.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,935.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,626.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,578.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,578.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,578.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,867.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,578.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,578.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,867.83,
DISP TENO SCREW,2004913,CDM,270,RC,,,outpatient,,,464.5,232.25,,450.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,278.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,418.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,418.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,278.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,337.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,317.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,278.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,374.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,374.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,411.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,307.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,376.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,427.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,441.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,450.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,301.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,278.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,278.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,278.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,418.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,278.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,278.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,418.05,
BREAKAWAY NOZZLE  FEMORAL,2004914,CDM,270,RC,,,outpatient,,,214,107,,207.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,128.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,192.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,192.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,146.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,128.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,172.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,189.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,141.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,173.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,196.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,203.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,207.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,128.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,128.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,192.6,
BLADE SAGITAL SERIES 2108 24.9X0.64,2004915,CDM,270,RC,,,outpatient,,,151.75,75.88,,147.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,136.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,103.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,122.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,100.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,122.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,139.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,144.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,147.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,136.58,
BLADE PRESISION THIN,2004916,CDM,270,RC,,,outpatient,,,151.75,75.88,,147.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,136.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,103.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,122.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,100.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,122.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,139.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,144.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,147.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,136.58,
DRILL BIT 3.2x125,2004917,CDM,270,RC,,,outpatient,,,408,204,,395.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,244.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,367.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,367.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,244.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,296.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,278.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,244.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,329.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,329.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,361.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,270.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,330.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,375.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,387.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,395.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,265.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,244.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,244.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,244.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,367.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,244.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,244.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,367.2,
DRILL BIT 2.5x125,2004918,CDM,270,RC,,,outpatient,,,446.75,223.38,,433.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,268.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,402.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,402.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,268.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,325.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,304.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,268.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,360.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,360.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,395.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,296.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,361.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,411.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,424.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,433.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,290.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,268.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,268.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,268.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,402.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,268.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,268.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,402.08,
TRIATHLON PS FEM,2004919,CDM,270,RC,,,outpatient,,,5694.75,2847.38,,5523.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,3416.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1708.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,5125.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,5125.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,3416.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4143.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3886.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3416.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4596.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4596.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5046.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3775.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4612.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5239.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,5410.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,5523.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,3701.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,3416.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3416.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3416.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5125.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,3416.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3416.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,5125.28,
TRIATHLON PRIM TIB,2004920,CDM,270,RC,,,outpatient,,,3366.25,1683.13,,3265.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,2019.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1009.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,3029.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3029.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,2019.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2449.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2297.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2019.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2717.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2717.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2982.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2231.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2726.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3096.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,3197.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,3265.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,2188.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,2019.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2019.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2019.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3029.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,2019.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2019.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3029.63,
TRIATHLON PS X3 TIBIAL,2004921,CDM,270,RC,,,outpatient,,,3922.75,1961.38,,3805.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,2353.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1176.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,3530.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,3530.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2353.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2854.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2677.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2353.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3166.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3166.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3475.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2600.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3177.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3608.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,3726.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,3805.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,2549.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,2353.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2353.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2353.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3530.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2353.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2353.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3530.48,
TRIATHLON ASYMMETRICX3,2004922,CDM,270,RC,,,outpatient,,,1945.5,972.75,,1887.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,1167.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,583.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,1750.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,1750.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,1167.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1415.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1327.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1167.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1570.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1570.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1723.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1289.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1575.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1789.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,1848.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,1887.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,1264.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,1167.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1167.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1167.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1750.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,1167.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1167.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1750.95,
FLUTED HEADLESS 1/8,2004923,CDM,270,RC,,,outpatient,,,1074.75,537.38,,1042.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,644.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,967.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,967.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,644.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,781.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,733.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,644.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,867.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,867.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,952.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,712.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,870.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,988.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,1021.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,1042.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,698.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,644.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,644.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,644.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,967.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,644.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,644.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,967.28,
SECUR FIT,2004924,CDM,270,RC,,,outpatient,,,8017.5,4008.75,,7776.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,4810.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2405.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,7215.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,7215.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4810.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5833.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5471.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4810.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6471.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6471.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7104.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5315.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6494.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7376.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,7616.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,7776.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,5211.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,4810.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4810.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4810.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7215.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4810.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4810.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,7215.75,
SCREW 6.5 CAN BONE,2004925,CDM,278,RC,,,outpatient,,,202.5,101.25,,196.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,182.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,138.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,121.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,163.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,179.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,134.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,164.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,186.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,192.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,196.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,121.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,121.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,182.25,
TRIDENT CLUSTER 46MM,2004926,CDM,270,RC,,,outpatient,,,2911,1455.5,,2823.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1746.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,873.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,2619.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,2619.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,1746.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2118.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1986.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1746.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2349.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2349.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2579.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1929.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2357.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2678.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,2765.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,2823.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1892.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,1746.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1746.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1746.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2619.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,1746.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1746.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2619.9,
TRIDENT CLUSTER 50MM,2004927,CDM,270,RC,,,outpatient,,,2911,1455.5,,2823.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1746.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,873.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,2619.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,2619.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,1746.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2118.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1986.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1746.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2349.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2349.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2579.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1929.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2357.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2678.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,2765.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,2823.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1892.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,1746.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1746.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1746.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2619.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,1746.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1746.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2619.9,
TRIDENT 10X3 INSERT,2004928,CDM,270,RC,,,outpatient,,,2852,1426,,2766.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,1711.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,855.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,2566.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2566.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1711.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2075.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1946.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1711.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2302.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2302.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2527.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1890.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2310.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2623.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,2709.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,2766.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,1853.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,1711.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1711.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1711.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2566.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1711.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1711.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2566.8,
BIOLOX DELTA HEAD,2004929,CDM,270,RC,,,outpatient,,,2786,1393,,2702.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,1671.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,835.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,2507.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,2507.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,1671.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2027.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1901.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1671.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2248.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2248.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2468.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1847.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2256.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2563.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,2646.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,2702.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,1810.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,1671.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1671.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1671.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2507.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,1671.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1671.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2507.4,
AIRFIT F20 SMALL,2004930,CDM,270,RC,,,outpatient,,,79,39.5,,76.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,53.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,63.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,72.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,76.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.4,90,
AIRFIT F20 LARGE,2004931,CDM,270,RC,,,outpatient,,,79,39.5,,76.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,53.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,63.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,72.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,76.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.4,90,
AIRFIT F30 LG,2004932,CDM,270,RC,,,outpatient,,,81.25,40.63,,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,55.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,65.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,74.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,77.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,90,
CHIN STRAP DELUXE,2004933,CDM,270,RC,,,outpatient,,,130.25,65.13,,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,88.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,105.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,119.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,123.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117.23,
AIRFIT F-10 SLIM MED,2004934,CDM,270,RC,,,outpatient,,,81.25,40.63,,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,55.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,65.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,74.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,77.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,90,
AIRFIT F-10 SLIM LG,2004935,CDM,270,RC,,,outpatient,,,81.25,40.63,,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,55.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,65.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,74.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,77.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,90,
MICRO BLADE 9.0X18.5,2004940,CDM,270,RC,,,outpatient,,,192,96,,186.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,131.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,170.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,127.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,155.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,176.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,182.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,186.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,172.8,
MICRO BLADE 9.0X25.0,2004941,CDM,270,RC,,,outpatient,,,192,96,,186.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,131.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,170.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,127.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,155.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,176.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,182.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,186.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,172.8,
MICRO BLADE 5.5X11.5,2004942,CDM,270,RC,,,outpatient,,,192,96,,186.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,131.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,170.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,127.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,155.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,176.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,182.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,186.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,172.8,
MICRO BLADE 5.5X18.0,2004943,CDM,270,RC,,,outpatient,,,192,96,,186.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,131.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,170.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,127.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,155.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,176.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,182.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,186.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,172.8,
MICRO BLADE 2.5X18.0,2004944,CDM,270,RC,,,outpatient,,,192,96,,186.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,131.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,170.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,127.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,155.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,176.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,182.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,186.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,172.8,
BREAKAWAY NOZZLE  FEMORAL,2004945,CDM,270,RC,,,outpatient,,,129.25,64.63,,125.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,116.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,116.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,88.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,77.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,104.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,85.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,104.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,118.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,122.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,125.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,77.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,77.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,116.33,
CHIN STRAP PREMIUM,2004946,CDM,270,RC,,,outpatient,,,81.25,40.63,,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,55.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,65.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,74.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,77.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,90,
AIRFIT F-10 SMALL,2004947,CDM,270,RC,,,outpatient,,,81.25,40.63,,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,55.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,65.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,74.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,77.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,90,
D/M 2.0MM SS BEADED,2004948,CDM,270,RC,,,outpatient,,,1200.5,600.25,,1164.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,720.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,360.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,1080.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,1080.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,720.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,873.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,819.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,720.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,969.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,969.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1063.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,795.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,972.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1104.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,1140.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,1164.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,780.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,720.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,720.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,720.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1080.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,720.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,720.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1080.45,
V40 COCR LIFT HEAD 28MM,2004949,CDM,278,RC,,,outpatient,,,1206,603,,1169.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,723.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,361.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,1085.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,1085.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,723.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,877.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,823.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,723.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,973.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,973.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1068.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,799.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,976.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1109.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,1145.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,1169.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,783.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,723.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,723.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,723.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1085.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,723.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,723.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1085.4,
HEMO VAC,2004950,CDM,272,RC,,,outpatient,,,57,28.5,,55.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,51.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,34.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,46.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,52.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,54.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,55.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,34.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,34.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.2,90,
UHR BIPOLAR 28X50MM,2004951,CDM,278,RC,,,outpatient,,,1630,815,,1581.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,978,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,489,30,,,percent of total billed charges,Pays at 30% of total billed charges,1467,90,,,percent of total billed charges,Pays at 90% of total billed charges,1467,90,,,percent of total billed charges,Pays at 90% of total billed charges,978,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1185.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1112.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,978,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1315.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1315.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1444.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1080.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1320.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1499.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,1548.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,1581.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,1059.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,978,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,978,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,978,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1467,90,,,percent of total billed charges,Pays at 90% of total billed charges,978,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,978,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1467,
HII MRI PIN -ROD COUPLING 4,2004952,CDM,270,RC,,,outpatient,,,1812.75,906.38,,1758.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,1087.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,543.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,1631.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1631.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1087.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1318.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1237.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1087.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1463.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1463.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1606.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1201.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1468.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1667.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,1722.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,1758.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,1178.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,1087.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1087.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1087.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1631.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1087.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1087.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1631.48,
APEX TRANSFIX 4X250 PIN,2004953,CDM,270,RC,,,outpatient,,,478.5,239.25,,464.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,287.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,430.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,430.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,287.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,348.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,326.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,287.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,386.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,386.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,424,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,317.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,387.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,440.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,454.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,464.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,311.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,287.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,430.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,287.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,287.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,430.65,
STERILE HII COMP MODULAR KIT,2004954,CDM,270,RC,,,outpatient,,,10080,5040,,9777.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,6048,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3024,30,,,percent of total billed charges,Pays at 30% of total billed charges,9072,90,,,percent of total billed charges,Pays at 90% of total billed charges,9072,90,,,percent of total billed charges,Pays at 90% of total billed charges,6048,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7334.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6879.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6048,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8136.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8136.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8931.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6683.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8164.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9273.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,9576,95,,,percent of total billed charges,Pays at 95% of total billed charges,9777.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,6552,65,,,percent of total billed charges,Pays at 65% of total billed charges,6048,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6048,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6048,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9072,90,,,percent of total billed charges,Pays at 90% of total billed charges,6048,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6048,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,9072,
AIRFIT P-10 SLIM LG,2004955,CDM,270,RC,,,outpatient,,,81.25,40.63,,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,55.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,65.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,74.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,77.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,90,
TIP HIGH CAPACITY IM4,2004956,CDM,272,RC,,,outpatient,,,114.5,57.25,,111.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,103.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,68.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,75.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,92.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,105.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,108.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,68.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,68.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.05,
AIRFIT F-30 SMALL,2004957,CDM,270,RC,,,outpatient,,,49.75,24.88,,48.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,44.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,33.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,32.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,40.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,45.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,47.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,48.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.85,90,
AIRFIT F-30 MED,2004958,CDM,270,RC,,,outpatient,,,81.25,40.63,,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,55.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,65.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,74.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,77.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,90,
AIRFIT N30i SMALL,2004959,CDM,270,RC,,,outpatient,,,71.75,35.88,,69.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,58.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,66.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,68.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.05,90,
AIRFIT N30i MED,2004960,CDM,270,RC,,,outpatient,,,71.75,35.88,,69.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,58.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,66.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,68.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.05,90,
WISP SMALL MASK,2004961,CDM,270,RC,,,outpatient,,,60.25,30.13,,58.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,41.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,53.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,39.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,48.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,55.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,57.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,58.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,90,
TRIATHLON PS FEM,2004962,CDM,270,RC,,,outpatient,,,5694.75,2847.38,,5523.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,3416.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1708.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,5125.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,5125.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,3416.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4143.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3886.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3416.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4596.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4596.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5046.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3775.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4612.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5239.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,5410.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,5523.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,3701.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,3416.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3416.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3416.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5125.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,3416.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3416.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,5125.28,
TRIATHLON PRIM TIB,2004963,CDM,270,RC,,,outpatient,,,3377.75,1688.88,,3276.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,2026.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1013.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,3039.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,3039.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,2026.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2457.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2305.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2026.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2726.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2726.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2993.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2239.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2735.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3107.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,3208.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,3276.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,2195.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,2026.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2026.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2026.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3039.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,2026.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2026.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3039.98,
TRIATHLON PS X3 TIB/INSERT,2004964,CDM,270,RC,,,outpatient,,,3377.75,1688.88,,3276.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,2026.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1013.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,3039.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,3039.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,2026.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2457.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2305.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2026.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2726.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2726.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2993.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2239.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2735.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3107.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,3208.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,3276.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,2195.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,2026.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2026.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2026.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3039.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,2026.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2026.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3039.98,
LONG IL KIT R 1/5 TI,2004965,CDM,278,RC,,,outpatient,,,8043.5,4021.75,,7802.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2413.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,7239.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,7239.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5852.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5489.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6492.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6492.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7127.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5332.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6515.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7400.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,7641.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,7802.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,5228.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7239.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4826.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,7239.15,
SCREWDRIVER BLADE,2004966,CDM,278,RC,,,outpatient,,,1113.75,556.88,,1080.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,668.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,334.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,1002.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,1002.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,668.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,810.36,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,760.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,668.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,899.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,899.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,986.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,738.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,902.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1024.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,1058.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,1080.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,723.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,668.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,668.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,668.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1002.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,668.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,668.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1002.38,
GAMMA CLOSED TUBE CLIP,2004967,CDM,270,RC,,,outpatient,,,333.25,166.63,,323.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,199.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,299.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,299.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,199.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,227.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,199.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,269,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,295.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,220.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,269.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,306.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,316.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,323.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,216.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,199.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,199.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,199.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,299.93,
TI TROCHANTERIC IL KIT 11X180MM,2004968,CDM,270,RC,,,outpatient,,,2695.75,1347.88,,2614.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,1617.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,808.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,2426.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,2426.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1617.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1961.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1839.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1617.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2176.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2176.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2388.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1787.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2183.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2480.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,2560.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,2614.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,1752.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,1617.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1617.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1617.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2426.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1617.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1617.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2426.18,
G7 OSSEOTI ACETABULAR SHELL 3 HOLE,2004969,CDM,278,RC,,,outpatient,,,5710.5,2855.25,,5539.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,3426.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,5139.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,5139.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,3426.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4154.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3897.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3426.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4609.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4609.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5060.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3786.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4625.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5253.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,5424.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,5539.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,3711.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,3426.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3426.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3426.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5139.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,3426.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3426.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,5139.45,
G7  ACETABULAR LINER HIGH WALL,2004970,CDM,278,RC,,,outpatient,,,2583,1291.5,,2505.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2324.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2324.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1879.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1762.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2085,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2085,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2288.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1712.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2092.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2376.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,2453.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2505.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,1678.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2324.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1549.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2324.7,
BIOLOX DELTA MODULAR CERAMIC HEAD,2004971,CDM,278,RC,,,outpatient,,,1347.75,673.88,,1307.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1212.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,1212.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,980.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,919.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1087.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1087.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1194.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,893.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1091.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1239.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,1280.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,1307.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,876.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1212.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1212.98,
ECHO BI-METRIC HIP ST FEMORAL STEM,2004972,CDM,278,RC,,,outpatient,,,3593.75,1796.88,,3485.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3234.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,3234.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2614.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2452.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2900.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2900.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3184.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2382.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2910.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3306.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,3414.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,3485.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,2335.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3234.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2156.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3234.38,
TWIST DRILL 1.9MM  AO END,2004973,CDM,270,RC,,,outpatient,,,232.25,116.13,,225.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,209.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,158.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,187.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,205.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,153.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,188.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,213.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,220.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,225.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,150.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,209.03,
PROFYLE HAND LOCK T 1.7S,2004974,CDM,270,RC,,,outpatient,,,683.75,341.88,,663.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,410.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,615.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,615.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,410.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,497.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,466.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,410.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,551.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,551.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,605.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,453.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,553.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,629.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,649.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,663.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,444.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,410.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,410.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,410.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,615.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,410.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,410.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,615.38,
Y-TYPE BLOOD SET,2005000,CDM,272,RC,,,outpatient,,,29.25,14.63,,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,90,
BAN NEB PEDIATRIC,2005002,CDM,270,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,90,
AEROECLIPSE DISP MED MASK,2005003,CDM,270,RC,,,outpatient,,,3.75,1.88,,3.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,90,
DIAL-A-FLOW,2005004,CDM,272,RC,,,outpatient,,,20,10,,19.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,30,,,percent of total billed charges,Pays at 30% of total billed charges,18,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,90,,,percent of total billed charges,Pays at 90% of total billed charges,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,18.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,19,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,13,65,,,percent of total billed charges,Pays at 65% of total billed charges,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,Pays at 90% of total billed charges,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12,90,
AEROECLIPSE DISP LRGMASK,2005005,CDM,270,RC,,,outpatient,,,3.75,1.88,,3.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,90,
SET INLINE BURRETTE,2005006,CDM,272,RC,,,outpatient,,,22.75,11.38,,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,90,
EXT SET WITH T,2005010,CDM,272,RC,,,outpatient,,,8.5,4.25,,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,90,
DRAIN CWV AXIOM,2005011,CDM,270,RC,,,outpatient,,,108.25,54.13,,105,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,95.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,71.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,87.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,99.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,102.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,105,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,97.43,
SALLY TUBE,2005013,CDM,272,RC,,,outpatient,,,26.5,13.25,,25.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,23.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,90,
FILTER SET 15,2005014,CDM,272,RC,,,outpatient,,,17.5,8.75,,16.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,15.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.5,90,
FILTER LINE SET,2005015,CDM,272,RC,,,outpatient,,,64.75,32.38,,62.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,58.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,52.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,59.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,62.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.85,90,
CHEST DRAIN SYSTEM,2005016,CDM,270,RC,,,outpatient,,,218,109,,211.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,130.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,196.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,148.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,130.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,175.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,175.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,193.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,144.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,176.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,200.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,207.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,211.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,141.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,130.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,130.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,196.2,
SMART CAPNOLINE,2005017,CDM,272,RC,,,outpatient,,,75.5,37.75,,73.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,69.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,73.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,90,
I V PIGGYBACK,2005018,CDM,272,RC,,,outpatient,,,16.25,8.13,,15.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,90,
STERI STRIP 1/4 X 3,2005019,CDM,272,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
STERI-STRIP 1/4 X 4,2005021,CDM,272,RC,,,outpatient,,,7.25,3.63,,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,90,
ST SHEAR,2005022,CDM,272,RC,,,outpatient,,,718.75,359.38,,697.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,431.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,646.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,646.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,431.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,522.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,490.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,431.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,580.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,580.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,636.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,476.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,582.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,661.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,682.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,697.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,467.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,431.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,431.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,431.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,646.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,431.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,431.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,646.88,
HARMONIC 23,2005023,CDM,272,RC,,,outpatient,,,1593.25,796.63,,1545.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,955.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,477.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,1433.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1433.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,955.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1159.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1087.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,955.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1286.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1286.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1411.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1056.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1290.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1465.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,1513.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,1545.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,1035.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,955.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,955.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,955.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1433.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,955.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,955.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1433.93,
HARMONIC 36,2005024,CDM,272,RC,,,outpatient,,,2136,1068,,2071.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,1281.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,640.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,1922.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,1922.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,1281.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1554.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1457.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1281.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1724.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1724.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1892.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1416.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1730.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1965.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,2029.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,2071.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,1388.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,1281.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1281.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1281.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1922.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,1281.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1281.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1922.4,
GASTRONOMY DEVICE 24FR. 2.4CM,2005026,CDM,272,RC,,,outpatient,,,258.25,129.13,,250.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,232.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,176.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,228.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,171.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,209.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,237.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,245.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,250.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,167.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,232.43,
GASTRONOMY DEVICE 24FR. 3.4CM,2005027,CDM,272,RC,,,outpatient,,,258.25,129.13,,250.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,232.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,176.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,228.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,171.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,209.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,237.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,245.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,250.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,167.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,232.43,
TUBING  CONNECTING,2005029,CDM,272,RC,,,outpatient,,,56,28,,54.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,50.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,45.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,51.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,53.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,33.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.6,90,
JELCO 24 GA IV,2005030,CDM,272,RC,,,outpatient,,,7.25,3.63,,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,90,
NEEDLE HUBER 22GA,2005031,CDM,272,RC,,,outpatient,,,29.5,14.75,,28.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,26.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,27.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.7,90,
JELCO 22GA IV ANGOCATH,2005032,CDM,272,RC,,,outpatient,,,7.25,3.63,,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,90,
HUBAR NEEDLE 20 GA,2005033,CDM,272,RC,,,outpatient,,,31.25,15.63,,30.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.75,90,
JELCO 20GA IV,2005034,CDM,272,RC,,,outpatient,,,7.25,3.63,,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,90,
NEEDLE HUBER 20GA 3/4 INCH,2005035,CDM,272,RC,,,outpatient,,,29.25,14.63,,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,90,
JELCO 18GA IV,2005036,CDM,272,RC,,,outpatient,,,7.25,3.63,,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,90,
RAD ARTERY CATH KIT,2005037,CDM,272,RC,,,outpatient,,,77.25,38.63,,74.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,69.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,46.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,51.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,62.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,71.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,73.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,46.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,46.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.35,90,
JELCO 16GA IV,2005038,CDM,272,RC,,,outpatient,,,7.25,3.63,,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,90,
WOUND/VAC/ CANISTER 500ML,2005039,CDM,270,RC,,,outpatient,,,179.75,89.88,,174.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,161.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,161.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,122.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,145.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,159.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,119.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,145.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,165.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,170.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,174.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,116.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,161.78,
JELCO 14GA IV,2005040,CDM,272,RC,,,outpatient,,,7,3.5,,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,90,
INVIA GAUZE DRESSING KIT,2005041,CDM,272,RC,,,outpatient,,,103,51.5,,99.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,92.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,70.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,61.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,68.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,94.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,97.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,99.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,61.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,92.7,
SET BUTTERFLY 25 GA,2005042,CDM,272,RC,,,outpatient,,,17.75,8.88,,17.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,15.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.65,90,
OXIMIZER MASK RES CANNULA,2005043,CDM,272,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,90,
OXYMASK OPEN 02MED,2005045,CDM,270,RC,,,outpatient,,,9.25,4.63,,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,90,
OXYPLUS OPEN 02 LARGE,2005047,CDM,270,RC,,,outpatient,,,11,5.5,,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,90,
NEEDLE /INJECTION,2005049,CDM,272,RC,,,outpatient,,,111.5,55.75,,108.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,100.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,73.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,105.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,100.35,
NEEDLE BIO INSTRUMENT,2005051,CDM,272,RC,,,outpatient,,,252.25,126.13,,244.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,227.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,227.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,151.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183.54,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,172.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,151.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,203.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,223.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,167.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,204.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,232.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,239.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,244.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,163.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,151.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,151.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,151.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,227.03,
IV TUBING 10 DROP SEC,2005052,CDM,272,RC,,,outpatient,,,5.25,2.63,,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,90,
IV TUBING 10 DROP PRIME,2005054,CDM,272,RC,,,outpatient,,,16,8,,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.6,90,
WOUND/VAC CANISTER 300ML,2005055,CDM,270,RC,,,outpatient,,,164.75,82.38,,159.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,148.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,148.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,112.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,98.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,145.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,109.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,133.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,151.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,156.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,159.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,107.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,98.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,98.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,148.28,
UNIVERSAL PRIMARY 20DROP,2005056,CDM,272,RC,,,outpatient,,,17.5,8.75,,16.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,15.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.5,90,
SPOT,2005057,CDM,272,RC,,,outpatient,,,154.25,77.13,,149.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,92.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,138.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,138.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,105.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,92.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,124.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,102.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,124.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,141.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,146.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,149.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,92.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,92.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,138.83,
UNIVERSAL SECONDARY 20,2005058,CDM,272,RC,,,outpatient,,,6.25,3.13,,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,90,
ATS CANISTER W/GEL,2005059,CDM,272,RC,,,outpatient,,,108.75,54.38,,105.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,97.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,74.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,72.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,88.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,100.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,103.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,105.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,97.88,
MANIFOLD 3WAY STOPCOCK,2005060,CDM,272,RC,,,outpatient,,,12.5,6.25,,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,90,
IV 60 DROP VENT,2005061,CDM,272,RC,,,outpatient,,,11.25,5.63,,10.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,90,
SAL BALLOON INVOTEC,2005062,CDM,272,RC,,,outpatient,,,238,119,,230.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,142.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,214.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,214.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,162.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,142.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,192.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,210.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,157.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,192.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,218.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,226.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,230.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,154.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,142.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,142.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,214.2,
DRESSING INVIAFOAMLARGE,2005063,CDM,272,RC,,,outpatient,,,182.75,91.38,,177.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,124.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,161.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,148.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,168.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,173.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,177.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,164.48,
BLADE INDOTRAC,2005065,CDM,272,RC,,,outpatient,,,427.5,213.75,,414.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,256.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,384.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,384.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,256.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,311.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,291.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,256.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,345.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,345.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,378.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,283.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,346.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,393.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,406.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,414.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,277.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,256.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,256.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,256.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,384.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,256.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,256.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,384.75,
ROSEN CURVED GUIDE WIRE,2005067,CDM,272,RC,,,outpatient,,,108.75,54.38,,105.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,97.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,74.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,72.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,88.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,100.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,103.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,105.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,97.88,
DILATOR 6 FR,2005068,CDM,272,RC,,,outpatient,,,57.5,28.75,,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,46.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,52.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,54.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,90,
DILATOR 7 FR,2005069,CDM,272,RC,,,outpatient,,,57.5,28.75,,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,46.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,52.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,54.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,90,
DILATOR 8 FR,2005070,CDM,272,RC,,,outpatient,,,57.5,28.75,,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,46.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,52.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,54.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,90,
NEEDLE SELDINGER,2005071,CDM,272,RC,,,outpatient,,,34.75,17.38,,33.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,31.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.85,90,
CATH DRAIGE APD 8FR,2005072,CDM,272,RC,,,outpatient,,,231.75,115.88,,224.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,208.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,208.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,158.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,139.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,187.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,205.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,153.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,187.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,213.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,220.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,224.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,150.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,139.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,139.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,208.58,
TUBING CONNECT          X-RAY,2005073,CDM,272,RC,,,outpatient,,,71,35.5,,68.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,63.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,57.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,65.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,67.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,68.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.6,90,
RAD ARTERY CATH KIT ANTH,2005076,CDM,272,RC,,,outpatient,,,41,20.5,,39.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,36.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.6,90,
FLO SEAL APPLICATOR,2005078,CDM,272,RC,,,outpatient,,,159,79.5,,154.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,143.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,143.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,108.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,95.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,140.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,105.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,128.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,146.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,151.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,154.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,95.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,95.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,143.1,
BONE MARROW NEEDLE,2005081,CDM,272,RC,,,outpatient,,,62.5,31.25,,60.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,56.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,42.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,50.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,57.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,59.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,60.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.5,90,
DISP BIOPSY NEEDLE,2005082,CDM,272,RC,,,outpatient,,,88.75,44.38,,86.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,79.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,53.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,81.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,84.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,86.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,53.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,53.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.25,90,
GRASPERS,2005085,CDM,272,RC,,,outpatient,,,235.25,117.63,,228.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,141.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,211.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,211.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,160.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,141.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,189.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,189.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,155.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,190.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,216.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,223.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,228.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,152.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,141.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,211.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,141.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,211.73,
VAG CERVICAL RETRACTOR MED,2005086,CDM,272,RC,,,outpatient,,,229.75,114.88,,222.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,206.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,206.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,156.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,185.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,203.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,152.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,186.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,211.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,218.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,222.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,149.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,206.78,
VAG CERVICAL RETRACTOR  SMALL,2005087,CDM,272,RC,,,outpatient,,,230,115,,223.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,138,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,30,,,percent of total billed charges,Pays at 30% of total billed charges,207,90,,,percent of total billed charges,Pays at 90% of total billed charges,207,90,,,percent of total billed charges,Pays at 90% of total billed charges,138,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,156.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,138,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,185.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,203.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,152.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,186.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,211.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,218.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,223.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,149.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,138,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207,90,,,percent of total billed charges,Pays at 90% of total billed charges,138,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,138,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,207,
VAG CERVICAL RETRACTOR LARGE,2005088,CDM,272,RC,,,outpatient,,,229.75,114.88,,222.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,206.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,206.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,156.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,185.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,203.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,152.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,186.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,211.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,218.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,222.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,149.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,137.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,206.78,
BIOPSY NEEDLE PROSTATE DR EDGERTON,2005089,CDM,272,RC,,,outpatient,,,229.25,114.63,,222.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,137.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,206.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,206.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,156.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,137.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,185.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,203.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,151.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,185.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,210.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,217.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,222.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,149.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,137.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,137.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,206.33,
BOUGIE CURVED,2005091,CDM,272,RC,,,outpatient,,,34.75,17.38,,33.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,31.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.85,90,
MASK LARNGEAL DEVICE3.0,2005094,CDM,272,RC,,,outpatient,,,24.75,12.38,,24.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,90,
MASK LARNGEAL DEVICE5.0,2005095,CDM,272,RC,,,outpatient,,,27.5,13.75,,26.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,90,
NEEDLE GUIDE ENDOCAVITY,2005096,CDM,272,RC,,,outpatient,,,75,37.5,,72.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,67.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,49.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,60.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,69,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,72.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45,90,
ELEVATE ANTERIOR +APICAL SYSTEM,2005097,CDM,272,RC,,,outpatient,,,4989.5,2494.75,,4839.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,2993.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1496.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,4490.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,4490.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,2993.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3630.36,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3405.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2993.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4027.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4027.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4421.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3308.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4041.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4590.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,4740.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,4839.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3243.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,2993.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2993.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2993.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4490.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,2993.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2993.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4490.55,
IV  PRIME SOLUTION SET,2005098,CDM,272,RC,,,outpatient,,,14,7,,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,90,
EXT SET clearlink,2005099,CDM,272,RC,,,outpatient,,,10.25,5.13,,9.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.15,90,
EXT SET HIGH FLOW,2005100,CDM,272,RC,,,outpatient,,,4.25,2.13,,4.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,4.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,90,
ELEVATE POSTERIOR +APICAL SYSTEM,2005101,CDM,272,RC,,,outpatient,,,4241.25,2120.63,,4114.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,2544.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1272.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,3817.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,3817.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,2544.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3085.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2894.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2544.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3423.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3423.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3758.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2811.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3435.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3901.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,4029.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,4114.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,2756.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,2544.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2544.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2544.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3817.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,2544.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2544.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3817.13,
PARAGARD IUD,2005102,CDM,636,RC,,,outpatient,,,576,288,,558.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,345.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,808.5,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,518.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,518.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,345.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,419.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,393.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,345.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,464.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,464.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,510.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,381.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,466.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,529.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,547.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,558.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,374.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,345.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,345.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,345.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,518.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,345.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,345.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,518.4,
PLEUR EVAC A-6000,2005103,CDM,270,RC,,,outpatient,,,186,93,,180.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,167.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,167.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,126.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,164.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,123.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,150.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,171.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,176.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,180.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,120.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,111.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,167.4,
ADAPTER AIRWAY CO2,2005104,CDM,272,RC,,,outpatient,,,18,9,,17.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,90,
Co2 LL LINE,2005105,CDM,272,RC,,,outpatient,,,38.25,19.13,,37.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,35.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,36.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.95,90,
N C Co2 LINE,2005106,CDM,272,RC,,,outpatient,,,13.5,6.75,,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,
TUBE SOPHARYNGEAL 24FR,2005107,CDM,272,RC,,,outpatient,,,19,9.5,,18.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,90,
TUBE SOPHARYNGEAL 26FR,2005108,CDM,270,RC,,,outpatient,,,19,9.5,,18.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,90,
TUBE SOPHARYNGEAL 28FR,2005109,CDM,270,RC,,,outpatient,,,19,9.5,,18.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,90,
TUBE SOPHARYNGEAL 34FR,2005110,CDM,270,RC,,,outpatient,,,19,9.5,,18.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,90,
PIGTAIL APDL CATHSYSTEM,2005111,CDM,272,RC,,,outpatient,,,216.25,108.13,,209.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,129.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,129.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,147.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,129.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,191.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,143.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,175.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,198.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,205.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,209.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,129.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,129.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,129.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,194.63,
TOUHY NEEDLE 18GA 3 1/2,2005112,CDM,272,RC,,,outpatient,,,21,10.5,,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,90,
LNCS SINGLE PT EAR PROB,2005113,CDM,271,RC,,,outpatient,,,119.5,59.75,,115.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,107.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,81.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,96.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,109.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,113.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,115.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,107.55,
SYRINGE ARTERIAL BLOOD GAS,2005114,CDM,272,RC,,,outpatient,,,6,3,,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,
PICO ARTERIAL BLOOD GAS,2005115,CDM,272,RC,,,outpatient,,,10.75,5.38,,10.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,90,
FILTER HME,2005119,CDM,272,RC,,,outpatient,,,13,6.5,,12.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,90,
LIFESHIELD PRN ADAPTOR,2005120,CDM,272,RC,,,outpatient,,,6,3,,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,
MESH BARD 26CM X 36CM,2005123,CDM,278,RC,,,outpatient,,,590.25,295.13,,572.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,354.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,531.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,531.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,354.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,429.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,402.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,354.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,476.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,476.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,523.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,391.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,478.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,543.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,560.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,572.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,383.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,354.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,354.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,354.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,531.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,354.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,354.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,531.23,
CORD CLAMP CLIPPER,2005124,CDM,272,RC,,,outpatient,,,34,17,,32.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,31.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,32.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.4,90,
SHEEP WOOL/DEUB.PAD,2005125,CDM,271,RC,,,outpatient,,,27.75,13.88,,26.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,90,
NEEDLE SIDEKICK RIGID,2005127,CDM,272,RC,,,outpatient,,,235.25,117.63,,228.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,141.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,211.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,211.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,160.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,141.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,189.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,189.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,155.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,190.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,216.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,223.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,228.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,152.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,141.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,211.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,141.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,211.73,
TOE IMPLANT B,2005130,CDM,278,RC,,,outpatient,,,2401,1200.5,,2328.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1440.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,720.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,2160.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,2160.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,1440.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1746.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1638.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1440.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1938.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1938.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2127.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1591.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1944.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2208.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,2280.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,2328.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1560.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,1440.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1440.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1440.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2160.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,1440.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1440.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2160.9,
MESH 15X20,2005131,CDM,278,RC,,,outpatient,,,6311.75,3155.88,,6122.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,3787.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,5680.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,5680.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,3787.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4592.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4307.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3787.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5094.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5094.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5592.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4184.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5112.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5806.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,5996.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,6122.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,4102.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,3787.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3787.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3787.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5680.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,3787.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3787.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,5680.58,
MESH 20X30,2005132,CDM,278,RC,,,outpatient,,,5213.5,2606.75,,5057.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,3128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4692.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4692.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,3128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3793.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3558.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4208.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4208.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4619.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3456.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4222.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4796.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,4952.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,5057.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,3388.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,3128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4692.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,3128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3128.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4692.15,
MESH 10X15,2005133,CDM,278,RC,,,outpatient,,,1495,747.5,,1450.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,897,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1345.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,1345.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,897,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1087.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1020.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,897,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1206.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1206.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1324.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,991.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1210.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1375.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,1420.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,1450.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,971.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,897,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,897,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,897,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1345.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,897,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,897,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1345.5,
MESH 15X19,2005134,CDM,278,RC,,,outpatient,,,2939.75,1469.88,,2851.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,1763.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2645.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,2645.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,1763.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2138.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2006.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1763.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2372.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2372.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2604.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1949.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2381.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2704.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,2792.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,2851.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,1910.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,1763.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1763.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1763.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2645.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,1763.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1763.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2645.78,
MESH 8X10,2005135,CDM,278,RC,,,outpatient,,,1964,982,,1905.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,1178.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1767.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,1767.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,1178.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1429.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1340.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1178.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1585.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1585.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1740.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1302.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1590.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1806.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,1865.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,1905.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,1276.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,1178.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1178.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1178.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1767.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,1178.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1178.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1767.6,
PROTACK,2005136,CDM,272,RC,,,outpatient,,,607,303.5,,588.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,364.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,546.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,546.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,364.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,441.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,414.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,364.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,489.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,489.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,537.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,402.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,491.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,558.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,576.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,588.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,394.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,364.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,364.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,364.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,546.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,364.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,364.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,546.3,
MARLEX MESH 3 X 6,2005137,CDM,278,RC,,,outpatient,,,132,66,,128.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,118.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,90.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,106.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,121.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,125.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,128.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,118.8,
MESH 14X9,2005138,CDM,278,RC,,,outpatient,,,756.75,378.38,,734.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,454.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,681.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,681.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,454.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,550.61,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,516.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,454.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,610.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,610.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,670.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,501.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,612.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,696.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,718.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,734.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,491.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,454.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,454.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,454.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,681.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,454.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,454.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,681.08,
MESH BARD 2.5CM X 10CM,2005139,CDM,278,RC,,,outpatient,,,215,107.5,,208.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,129,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,193.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,193.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,129,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,146.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,129,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,173.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,190.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,142.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,174.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,197.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,204.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,208.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,129,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,129,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,129,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,193.5,
MESH 15X15,2005140,CDM,278,RC,,,outpatient,,,780,390,,756.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,468,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,702,90,,,percent of total billed charges,Pays at 90% of total billed charges,702,90,,,percent of total billed charges,Pays at 90% of total billed charges,468,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,567.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,532.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,468,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,629.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,629.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,691.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,517.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,631.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,717.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,741,95,,,percent of total billed charges,Pays at 95% of total billed charges,756.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,507,65,,,percent of total billed charges,Pays at 65% of total billed charges,468,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,468,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,468,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,702,90,,,percent of total billed charges,Pays at 90% of total billed charges,468,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,468,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,702,
ABSORBATACK,2005141,CDM,272,RC,,,outpatient,,,1192,596,,1156.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,715.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,357.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,1072.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1072.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,715.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,867.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,813.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,715.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,962.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,962.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1056.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,790.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,965.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1096.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,1132.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,1156.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,774.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,715.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,715.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,715.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1072.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,715.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,715.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1072.8,
MESH GORE BIO A,2005142,CDM,278,RC,,,outpatient,,,1610.5,805.25,,1562.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,966.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1449.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,1449.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,966.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1171.8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1099.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,966.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1300,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1300,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1427.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1067.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1304.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1481.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,1529.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,1562.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,1046.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,966.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,966.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,966.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1449.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,966.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,966.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1449.45,
STATLOCK PICC PLUS,2005144,CDM,272,RC,,,outpatient,,,35.5,17.75,,34.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,90,
SPACEMAKER PLUS,2005145,CDM,272,RC,,,outpatient,,,1636.25,818.13,,1587.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,981.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,490.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,1472.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,1472.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,981.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1190.54,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1116.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,981.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1320.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1320.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1449.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1084.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1325.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1505.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,1554.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,1587.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,1063.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,981.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,981.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,981.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1472.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,981.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,981.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1472.63,
FLO SEAL  10ML,2005146,CDM,250,RC,,,outpatient,,,779.25,389.63,,755.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,467.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,233.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,701.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,701.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,467.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,566.98,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,531.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,467.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,629.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,629.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,690.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,516.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,631.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,716.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,740.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,755.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,506.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,467.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,467.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,467.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,701.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,467.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,467.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,701.33,
TROCAR BALLOON 5MM,2005147,CDM,272,RC,,,outpatient,,,316.5,158.25,,307.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,189.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,284.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,284.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,189.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,230.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,216.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,189.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,255.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,255.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,280.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,209.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,256.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,291.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,300.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,307.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,205.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,189.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,189.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,189.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,284.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,189.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,189.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,284.85,
KIDNEY SHAPED BALLOON,2005148,CDM,272,RC,,,outpatient,,,582.5,291.25,,565.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,349.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,524.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,524.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,349.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,423.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,397.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,349.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,470.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,470.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,516.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,386.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,471.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,535.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,553.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,565.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,378.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,349.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,349.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,349.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,524.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,349.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,349.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,524.25,
ANTI REFLUX VALVE,2005149,CDM,272,RC,,,outpatient,,,27.25,13.63,,26.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,24.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.35,90,
MESH VICRYL 12X12,2005150,CDM,278,RC,,,outpatient,,,4009.75,2004.88,,3889.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,2405.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3608.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,3608.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,2405.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2917.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2736.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2405.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3236.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3236.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3553.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2658.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3247.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3688.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,3809.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,3889.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,2606.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,2405.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2405.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2405.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3608.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,2405.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2405.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3608.78,
CUFF DISP 18'',2005151,CDM,272,RC,,,outpatient,,,98.25,49.13,,95.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,88.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,58.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,79.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,90.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,93.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,95.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,58.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,58.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.95,90,
CUFF DISP 24'',2005152,CDM,272,RC,,,outpatient,,,105.75,52.88,,102.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,95.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,72.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,85.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,97.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,100.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,102.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,63.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,95.18,
PROLENE MESH,2005153,CDM,272,RC,,,outpatient,,,420.25,210.13,,407.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,252.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,378.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,378.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,305.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,286.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,252.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,339.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,339.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,372.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,278.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,340.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,386.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,399.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,407.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,273.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,252.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,378.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,252.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,378.23,
MESH -PHYSIO 1520V  15X20,2005154,CDM,278,RC,,,outpatient,,,3216,1608,,3119.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,1929.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2894.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,2894.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,1929.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2339.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2194.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1929.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2595.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2595.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2849.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2132.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2604.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2958.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,3055.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,3119.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,2090.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,1929.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1929.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1929.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2894.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,1929.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1929.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2894.4,
MESH -PHYSIO 2025V 20X25,2005155,CDM,278,RC,,,outpatient,,,5802.25,2901.13,,5628.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,3481.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,5222.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,5222.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,3481.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4221.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3960.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3481.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4683.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4683.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5141.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3846.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4699.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5338.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,5512.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,5628.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,3771.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,3481.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3481.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3481.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5222.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,3481.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3481.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,5222.03,
MESH -PHYSIO 2535V  25X35,2005156,CDM,278,RC,,,outpatient,,,7551.25,3775.63,,7324.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,4530.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,6796.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,6796.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,4530.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5494.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5153.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4530.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6095.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6095.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6691.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5006.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6116.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6947.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,7173.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,7324.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,4908.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,4530.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4530.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4530.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6796.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,4530.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4530.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,6796.13,
MESH -PHYSIO 1515Q  15X15,2005157,CDM,278,RC,,,outpatient,,,1810.25,905.13,,1755.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,1086.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1629.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,1629.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,1086.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1317.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1235.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1086.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1461.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1461.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1604.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1200.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1466.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1665.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,1719.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,1755.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,1176.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,1086.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1086.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1086.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1629.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,1086.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1086.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1629.23,
5MM SECURE-STRAP,2005158,CDM,272,RC,,,outpatient,,,1497.75,748.88,,1452.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,898.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,449.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,1347.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,1347.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,898.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1089.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1022.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,898.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1208.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1208.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1327.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,993.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1213.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1377.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,1422.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,1452.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,973.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,898.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,898.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,898.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1347.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,898.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,898.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1347.98,
MESH 10X15X1,2005159,CDM,278,RC,,,outpatient,,,7628.25,3814.13,,7399.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,4576.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,6865.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,6865.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4576.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5550.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5206.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4576.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6157.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6157.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6759.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5057.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6178.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7017.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,7246.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,7399.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,4958.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,4576.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4576.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4576.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6865.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4576.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4576.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,6865.43,
MESH 15X20X1,2005160,CDM,278,RC,,,outpatient,,,18011.75,9005.88,,17471.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,10807.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,16210.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,16210.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,10807.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13105.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12293.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10807.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14539.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14539.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15960.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11941.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14589.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16570.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,17111.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,17471.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,11707.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,10807.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10807.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10807.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16210.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,10807.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10807.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,16210.58,
MESH  PERMACOL,2005161,CDM,278,RC,,,outpatient,,,38285.25,19142.63,,37136.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,22971.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,34456.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,34456.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,22971.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27856.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26129.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22971.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30903.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30903.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33924.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25383.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,31011.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,35222.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,36370.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,37136.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,24885.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,22971.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22971.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22971.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34456.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,22971.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22971.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,34456.73,
MESH -PHYSIO 7x15,2005162,CDM,278,RC,,,outpatient,,,1189.75,594.88,,1154.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,713.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1070.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,1070.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,713.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,865.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,812,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,713.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,960.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,960.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1054.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,788.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,963.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1094.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,1130.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,1154.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,773.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,713.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,713.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,713.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1070.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,713.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,713.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1070.78,
MESH SURGIMESH ONLAY,2005163,CDM,278,RC,,,outpatient,,,716.25,358.13,,694.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,429.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,644.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,644.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,429.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,521.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,488.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,429.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,578.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,578.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,634.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,474.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,580.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,658.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,680.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,694.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,465.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,429.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,429.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,429.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,644.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,429.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,429.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,644.63,
PERFIX LIGHT PLUG,2005164,CDM,278,RC,,,outpatient,,,912,456,,884.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,547.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,820.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,820.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,547.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,663.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,622.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,547.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,736.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,736.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,808.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,604.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,738.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,839.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,866.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,884.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,592.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,547.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,547.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,547.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,820.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,547.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,547.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,820.8,
MESH 6x13,2005165,CDM,278,RC,,,outpatient,,,716.25,358.13,,694.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,429.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,644.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,644.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,429.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,521.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,488.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,429.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,578.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,578.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,634.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,474.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,580.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,658.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,680.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,694.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,465.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,429.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,429.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,429.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,644.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,429.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,429.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,644.63,
MESH PERIETEX 9,2005167,CDM,278,RC,,,outpatient,,,1265.5,632.75,,1227.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,759.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1138.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,1138.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,759.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,920.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,863.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,759.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1021.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1021.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1121.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,839.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1025.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1164.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,1202.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,1227.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,822.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,759.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,759.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,759.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1138.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,759.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,759.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1138.95,
MESH PERIETEX 12,2005168,CDM,278,RC,,,outpatient,,,1735.25,867.63,,1683.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,1041.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1561.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1561.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1041.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1262.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1184.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1041.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1400.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1400.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1537.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1150.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1405.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1596.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,1648.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,1683.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,1127.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,1041.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1041.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1041.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1561.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1041.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1041.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1561.73,
MESH 3X6,2005169,CDM,278,RC,,,outpatient,,,288.25,144.13,,279.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,172.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,259.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,259.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,172.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,196.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,172.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,232.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,255.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,191.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,233.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,265.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,273.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,279.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,187.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,172.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,172.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,172.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,259.43,
BIOPSY VALVE SINGLE USE,2005170,CDM,272,RC,,,outpatient,,,1.75,0.88,,1.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,1.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.27,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,1.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,1.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,90,
MESH 7X10 HIATlL GRAFT,2005171,CDM,278,RC,,,outpatient,,,2500,1250,,2425,97,,,percent of total billed charges,Pays at 97% of total billed charges,1500,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2250,90,,,percent of total billed charges,Pays at 90% of total billed charges,2250,90,,,percent of total billed charges,Pays at 90% of total billed charges,1500,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1819,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1706.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1500,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2018,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2018,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2215.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1657.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2025,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2300,92,,,percent of total billed charges,Pays at 92% of total billed charges,2375,95,,,percent of total billed charges,Pays at 95% of total billed charges,2425,97,,,percent of total billed charges,Pays at 97% of total billed charges,1625,65,,,percent of total billed charges,Pays at 65% of total billed charges,1500,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1500,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1500,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2250,90,,,percent of total billed charges,Pays at 90% of total billed charges,1500,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1500,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2250,
MESH 7X10 HYBIRD HERNIA,2005172,CDM,278,RC,,,outpatient,,,3124.75,1562.38,,3031.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,1874.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2812.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,2812.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1874.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2273.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2132.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1874.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2522.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2522.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2768.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2071.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2531.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2874.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,2968.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,3031.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,2031.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,1874.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1874.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1874.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2812.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1874.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1874.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2812.28,
MESH UMBILICAL HERNIA,2005173,CDM,278,RC,,,outpatient,,,1219,609.5,,1182.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,731.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1097.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,1097.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,731.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,886.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,831.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,731.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,983.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,983.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1080.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,808.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,987.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1121.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,1158.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,1182.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,792.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,731.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,731.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,731.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1097.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,731.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,731.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1097.1,
MESH PERIETEX 15,2005174,CDM,278,RC,,,outpatient,,,2204.75,1102.38,,2138.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,1322.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1984.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1984.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1322.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1604.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1504.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1322.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1779.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1779.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1953.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1461.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1785.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2028.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,2094.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,2138.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,1433.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,1322.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1322.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1322.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1984.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1322.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1322.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1984.28,
LIGASURE SMALL JAW,2005175,CDM,272,RC,,,outpatient,,,1757.25,878.63,,1704.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,1054.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,527.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,1581.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,1581.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,1054.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1278.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1199.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1054.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1418.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1418.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1557.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1165.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1423.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1616.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,1669.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,1704.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,1142.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,1054.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1054.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1054.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1581.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,1054.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1054.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1581.53,
MESH PARIETEX 20X15,2005176,CDM,278,RC,,,outpatient,,,2783.25,1391.63,,2699.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,1669.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2504.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,2504.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1669.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2025.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1899.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1669.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2246.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2246.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2466.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1845.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2254.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2560.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,2644.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,2699.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,1809.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,1669.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1669.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1669.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2504.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1669.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1669.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2504.93,
ARTERIAL WRIST SUPPORT,2005177,CDM,270,RC,,,outpatient,,,32.5,16.25,,31.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,29.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,29.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,30.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,31.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.5,90,
MESH 30X20,2005178,CDM,278,RC,,,outpatient,,,5783.25,2891.63,,5609.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,3469.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,5204.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,5204.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,3469.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4207.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3947.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3469.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4668.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4668.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5124.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3834.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4684.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5320.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,5494.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,5609.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,3759.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,3469.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3469.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3469.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5204.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,3469.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3469.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,5204.93,
MESH PERIETEX 25X20,2005179,CDM,278,RC,,,outpatient,,,4230.25,2115.13,,4103.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,2538.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3807.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,3807.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,2538.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3077.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2887.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2538.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3414.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3414.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3748.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2804.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3426.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3891.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,4018.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,4103.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,2749.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,2538.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2538.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2538.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3807.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,2538.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2538.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3807.23,
MESH 37X28,2005180,CDM,278,RC,,,outpatient,,,6867,3433.5,,6660.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,4120.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,6180.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,6180.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4120.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4996.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4686.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4120.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5543.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5543.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6084.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4552.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5562.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6317.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,6523.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,6660.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,4463.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,4120.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4120.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4120.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6180.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4120.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4120.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,6180.3,
Co2 SAMPLING SAL; CANULA,2005181,CDM,272,RC,,,outpatient,,,9.5,4.75,,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,90,
PESSARY GELLHORN sz2,2005182,CDM,272,RC,,,outpatient,,,203.25,101.63,,197.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,182.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,138.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,164.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,180.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,134.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,164.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,186.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,193.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,197.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,132.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,182.93,
PESSARY GELLHORN sz2 1/4,2005183,CDM,272,RC,,,outpatient,,,200.75,100.38,,194.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,180.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,180.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,137.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,177.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,133.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,162.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,184.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,190.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,194.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,130.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,180.68,
PESSARY GELLHORN sz3 1/4,2005184,CDM,272,RC,,,outpatient,,,203.25,101.63,,197.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,182.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,138.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,164.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,180.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,134.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,164.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,186.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,193.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,197.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,132.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,182.93,
PESSARY RING  W/SUPPORT SZ5,2005188,CDM,272,RC,,,outpatient,,,166.75,83.38,,161.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,161.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.08,
PESSARY DONUT SZ2,2005189,CDM,272,RC,,,outpatient,,,166.75,83.38,,161.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,161.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.08,
PESSARY DONUT SZ4,2005190,CDM,272,RC,,,outpatient,,,166.75,83.38,,161.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,161.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.08,
PESSARY DONUT SZ5,2005191,CDM,272,RC,,,outpatient,,,166.75,83.38,,161.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,161.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.08,
PESSARY DONUT SZ6,2005192,CDM,272,RC,,,outpatient,,,166.75,83.38,,161.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,161.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.08,
PESSARY DONUT SZ7,2005193,CDM,272,RC,,,outpatient,,,166.75,83.38,,161.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,161.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.08,
TRANS PAK 2 ibp tubing,2005194,CDM,272,RC,,,outpatient,,,41.75,20.88,,40.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,38.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,39.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.05,90,
AMNIOEXCEL 15MM DISK,2005195,CDM,278,RC,,,outpatient,,,766,383,,743.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,459.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,689.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,689.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,459.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,557.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,522.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,459.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,618.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,618.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,678.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,507.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,620.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,704.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,727.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,743.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,497.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,459.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,459.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,459.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,689.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,459.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,459.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,689.4,
AMNIOEXCEL MESH2.0X3.0CM,2005196,CDM,278,RC,,,outpatient,,,2304.75,1152.38,,2235.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,1382.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2074.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,2074.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1382.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1676.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1572.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1382.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1860.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1860.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2042.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1528.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1866.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2120.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,2189.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,2235.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,1498.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,1382.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1382.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1382.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2074.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1382.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1382.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2074.28,
AMNIOEXCEL MESH 3.5X3.5CM,2005197,CDM,278,RC,,,outpatient,,,191.75,95.88,,186,97,,,percent of total billed charges,Pays at 97% of total billed charges,115.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,172.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,172.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,130.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,115.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,169.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,127.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,155.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,176.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,182.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,186,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,115.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,115.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,172.58,
MESH PROCEED 20.3CM X 25.4CM,2005198,CDM,278,RC,,,outpatient,,,1872.75,936.38,,1816.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,1123.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1685.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1685.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1123.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1362.61,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1278.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1123.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1511.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1511.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1659.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1241.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1516.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1722.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,1779.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,1816.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,1217.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,1123.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1123.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1123.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1685.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1123.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1123.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1685.48,
FILTER HYDRO 4MMX4MM,2005199,CDM,272,RC,,,outpatient,,,20.75,10.38,,20.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,90,
MESH PROCEED 25.4CM X 33CM,2005200,CDM,278,RC,,,outpatient,,,8725.75,4362.88,,8463.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,5235.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,7853.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,7853.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,5235.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6348.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5955.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5235.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7043.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7043.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7731.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5785.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7067.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8027.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,8289.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,8463.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,5671.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,5235.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5235.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5235.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7853.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,5235.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5235.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,7853.18,
MESH PROCEED RECTANGLE 3X6,2005201,CDM,278,RC,,,outpatient,,,1230.75,615.38,,1193.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,738.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1107.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1107.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,738.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,895.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,839.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,738.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,993.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,993.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1090.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,815.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,996.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1132.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,1169.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,1193.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,799.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,738.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,738.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,738.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1107.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,738.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,738.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1107.68,
MESH PROCEED SQUARE 6X6,2005202,CDM,278,RC,,,outpatient,,,2002.5,1001.25,,1942.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,1201.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1802.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1802.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1201.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1457.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1366.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1201.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1616.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1616.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1774.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1327.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1622.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1842.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,1902.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,1942.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,1301.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,1201.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1201.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1201.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1802.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1201.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1201.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1802.25,
MESH PROCEED 10.2CM X 15.2CM,2005203,CDM,278,RC,,,outpatient,,,1967,983.5,,1907.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,1180.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1770.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1770.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1180.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1431.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1342.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1180.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1587.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1587.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1742.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1304.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1593.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1809.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,1868.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,1907.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,1278.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,1180.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1180.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1180.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1770.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1180.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1180.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1770.3,
2.7 MM CORTEX SCREW,2005204,CDM,278,RC,,,outpatient,,,166.25,83.13,,161.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,149.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,134.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,152.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,157.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,161.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,149.63,
DRESSING INVIAFOAM SMALL,2005205,CDM,272,RC,,,outpatient,,,150,75,,145.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45,30,,,percent of total billed charges,Pays at 30% of total billed charges,135,90,,,percent of total billed charges,Pays at 90% of total billed charges,135,90,,,percent of total billed charges,Pays at 90% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,90,,,percent of total billed charges,Pays at 90% of total billed charges,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135,
DRESSING INVIA FOAM LARGE,2005206,CDM,272,RC,,,outpatient,,,182.75,91.38,,177.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,124.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,161.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,148.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,168.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,173.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,177.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,164.48,
PUSAVAC INTERPULSE,2005207,CDM,271,RC,,,outpatient,,,163.5,81.75,,158.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,147.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,147.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,111.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,98.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,131.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,144.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,108.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,132.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,150.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,155.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,158.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,98.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,98.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,147.15,
MESH BARD 7.6MMX15CM,2005208,CDM,278,RC,,,outpatient,,,290.25,145.13,,281.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,174.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,261.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,261.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,211.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,198.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,174.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,234.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,234.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,257.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,192.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,235.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,267.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,275.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,281.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,188.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,174.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,261.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,174.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,261.23,
PORT POWER IMPLANT 8FR,2005209,CDM,272,RC,,,outpatient,,,3643.75,1821.88,,3534.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,2186.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1093.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,3279.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,3279.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2186.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2651.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2486.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2186.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2941.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2941.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3228.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2415.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2951.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3352.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,3461.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,3534.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,2368.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,2186.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2186.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2186.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3279.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2186.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2186.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3279.38,
MESH MARLEX LRG,2005210,CDM,278,RC,,,outpatient,,,311.25,155.63,,301.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,280.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,280.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,212.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,251.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,275.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,206.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,252.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,286.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,295.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,301.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,202.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,280.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,280.13,
AMNIOEXCEL MEMBRAIN 4 CMX4CM,2005211,CDM,278,RC,,,outpatient,,,154,77,,149.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,92.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,138.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,138.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,105.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,92.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,124.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,102.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,124.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,141.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,146.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,149.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,92.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,92.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,138.6,
VAC WOUND,2005212,CDM,272,RC,,,outpatient,,,133.75,66.88,,129.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,88.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,108.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,123.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,127.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,129.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,120.38,
MESH PERIETEX 10X15,2005213,CDM,278,RC,,,outpatient,,,1635.5,817.75,,1586.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,981.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1471.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,1471.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,981.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1189.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1116.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,981.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1320.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1320.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1449.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1084.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1324.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1504.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,1553.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,1586.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,1063.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,981.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,981.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,981.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1471.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,981.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,981.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1471.95,
LIFESHIELD PRN ADAPTOR RT,2005214,CDM,272,RC,,,outpatient,,,5.5,2.75,,5.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,90,
MESH 3D MAX LIGHT,2005215,CDM,278,RC,,,outpatient,,,501.75,250.88,,486.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,301.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,451.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,451.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,301.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,365.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,342.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,301.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,405.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,405.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,444.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,332.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,406.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,461.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,476.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,486.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,326.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,301.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,301.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,301.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,451.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,301.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,301.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,451.58,
SORBAFIX ABSORB FIXATION DEVICE,2005216,CDM,278,RC,,,outpatient,,,761,380.5,,738.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,456.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,684.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,684.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,456.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,553.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,519.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,456.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,614.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,614.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,674.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,504.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,616.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,700.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,722.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,738.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,494.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,456.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,456.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,456.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,684.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,456.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,456.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,684.9,
PORT ACCESS 20GA,2005217,CDM,272,RC,,,outpatient,,,62.5,31.25,,60.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,56.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,42.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,50.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,57.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,59.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,60.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.5,90,
PORT ACCESS 22GA,2005218,CDM,272,RC,,,outpatient,,,62.5,31.25,,60.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,56.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,42.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,50.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,57.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,59.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,60.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.5,90,
SET IVADMIN DUOVENT CON FLO XRAY,2005219,CDM,272,RC,,,outpatient,,,16.5,8.25,,16.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,90,
CUFF DISP 8'',2005220,CDM,272,RC,,,outpatient,,,63,31.5,,61.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,56.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,51.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,57.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,59.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,61.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.8,90,
CUFF DISP 12'',2005221,CDM,272,RC,,,outpatient,,,70.5,35.25,,68.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,63.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,57.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,64.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,68.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.3,90,
PESSARY HODGE W/KNOB sz3 1/4,2005222,CDM,272,RC,,,outpatient,,,171.75,85.88,,166.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,154.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,154.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,117.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,138.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,113.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,139.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,158.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,163.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,166.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,154.58,
IV  FLUID ADMIN SET,2005223,CDM,272,RC,,,outpatient,,,179.5,89.75,,174.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,107.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,161.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,161.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,122.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,107.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,144.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,159.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,119.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,145.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,165.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,170.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,174.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,116.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,107.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,107.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,161.55,
DISP CORE BIOPSY INSTRUMENT,2005224,CDM,272,RC,,,outpatient,,,167,83.5,,161.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,161.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.3,
MESH BARD VENTRALIGHT ST 8,2005225,CDM,278,RC,,,outpatient,,,2311.5,1155.75,,2242.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,1386.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2080.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,2080.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,1386.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1681.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1577.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1386.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1865.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1865.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2048.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1532.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1872.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2126.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,2195.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,2242.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,1502.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,1386.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1386.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1386.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2080.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,1386.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1386.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2080.35,
PLEURX CATH KIT,2005226,CDM,272,RC,,,outpatient,,,1370.5,685.25,,1329.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,822.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,411.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,1233.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,1233.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,822.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,997.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,935.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,822.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1106.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1106.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1214.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,908.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1110.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1260.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,1301.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,1329.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,890.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,822.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,822.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,822.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1233.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,822.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,822.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1233.45,
PLEURX LINE ADAPTER,2005227,CDM,272,RC,,,outpatient,,,8,4,,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,90,
PLEURX VALVE CAP,2005228,CDM,272,RC,,,outpatient,,,28.25,14.13,,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,90,
PESSARY MILEX SZ 3,2005229,CDM,272,RC,,,outpatient,,,142.5,71.25,,138.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,128.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,97.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,94.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,115.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,131.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,135.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,138.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,92.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,128.25,
FILTER SET 15   0.22 MICRON,2005230,CDM,272,RC,,,outpatient,,,14.5,7.25,,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,90,
VAPOTHERM TUBING ADAPTER 22MM,2005231,CDM,270,RC,,,outpatient,,,13,6.5,,12.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,90,
HUBER NEEDLE 20 GA 1.5 in ER,2005232,CDM,272,RC,,,outpatient,,,29.5,14.75,,28.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,26.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,27.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.7,90,
MESH 15cm ventalex 8.0x8.0cm,2005233,CDM,278,RC,,,outpatient,,,1921.5,960.75,,1863.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,1152.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1729.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,1729.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,1152.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1398.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1311.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1152.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1551.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1551.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1702.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1273.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1556.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1767.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,1825.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,1863.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,1248.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,1152.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1152.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1152.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1729.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,1152.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1152.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1729.35,
MESH PARIETENE 25X20,2005234,CDM,278,RC,,,outpatient,,,3831.25,1915.63,,3716.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,2298.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3448.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,3448.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,2298.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2787.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2614.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2298.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3092.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3092.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3394.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2540.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3103.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3524.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,3639.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,3716.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,2490.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,2298.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2298.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2298.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3448.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,2298.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2298.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3448.13,
PESSARY GELLHORN sz2.5,2005235,CDM,272,RC,,,outpatient,,,142.25,71.13,,137.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,128.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,97.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,94.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,115.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,130.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,135.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,92.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,128.03,
GAUZE-VASDRESSING CUTICERIN,2005240,CDM,272,RC,,,outpatient,,,8,4,,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,90,
DRESSING ABSORPTIVEN,2005241,CDM,272,RC,,,outpatient,,,10.75,5.38,,10.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,90,
CUFF DISP 30'',2005253,CDM,272,RC,,,outpatient,,,113,56.5,,109.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,101.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,103.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,107.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,109.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,101.7,
CUFF DISP 34'',2005254,CDM,272,RC,,,outpatient,,,121.75,60.88,,118.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,98.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,115.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,118.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,109.58,
CUFF DISP 42'',2005255,CDM,272,RC,,,outpatient,,,106.5,53.25,,103.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,95.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,72.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,97.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,95.85,
CUFF DISP 12'' DOUBLE BLADDER,2005256,CDM,272,RC,,,outpatient,,,119.5,59.75,,115.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,107.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,81.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,96.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,109.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,113.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,115.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,107.55,
CUFF DISP 18'' DOUBLE BLADDER,2005257,CDM,272,RC,,,outpatient,,,161.5,80.75,,156.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,145.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,145.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,96.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,130.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,148.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,153.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,156.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,96.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,96.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,145.35,
CUFF DISP 24''' DOUBLE BLADDER,2005258,CDM,272,RC,,,outpatient,,,146.25,73.13,,141.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,99.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,129.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,96.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,118.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,134.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,138.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,141.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,131.63,
MESH 15cm ventalight,2005259,CDM,278,RC,,,outpatient,,,1358.25,679.13,,1317.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,814.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1222.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,1222.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,814.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,988.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,927.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,814.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1096.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1096.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1203.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,900.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1100.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1249.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,1290.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,1317.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,882.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,814.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,814.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,814.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1222.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,814.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,814.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1222.43,
ANKLE ORTHOSIS/SM AIRCAST,2005260,CDM,270,RC,,,outpatient,,,104.25,52.13,,101.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,93.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,93.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,71.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,69.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,84.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,95.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,99.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,101.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,62.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,93.83,
ANKLE ORTHOSIS/ST/ AIRCAST,2005261,CDM,270,RC,,,outpatient,,,104.25,52.13,,101.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,93.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,93.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,71.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,69.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,84.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,95.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,99.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,101.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,62.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,93.83,
ANKLE ORTHOSIS/ LACE UP XS,2005262,CDM,270,RC,,,outpatient,,,128,64,,124.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,115.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,87.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,84.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,103.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,117.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,121.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,124.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,115.2,
ANKLE ORTHOSIS/ LACE UP S,2005263,CDM,270,RC,,,outpatient,,,128,64,,124.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,115.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,87.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,84.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,103.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,117.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,121.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,124.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,115.2,
ANKLE ORTHOSIS/ LACE UP M,2005264,CDM,270,RC,,,outpatient,,,128,64,,124.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,115.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,87.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,84.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,103.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,117.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,121.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,124.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,115.2,
ANKLE ORTHOSIS/ LACE UP L,2005265,CDM,270,RC,,,outpatient,,,128,64,,124.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,115.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,87.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,84.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,103.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,117.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,121.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,124.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,115.2,
ANKLE ORTHOSIS/ LACE UP  XL,2005266,CDM,270,RC,,,outpatient,,,128,64,,124.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,115.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,87.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,84.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,103.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,117.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,121.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,124.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,115.2,
ANKLE ORTHOSIS/ LACE UP  XXL,2005267,CDM,270,RC,,,outpatient,,,128,64,,124.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,115.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,87.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,84.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,103.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,117.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,121.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,124.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,115.2,
WALKER FULL SHELL 2 XS,2005268,CDM,270,RC,,,outpatient,,,175.25,87.63,,169.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,157.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,119.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,116.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,141.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,161.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,166.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,169.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,157.73,
WALKER FULL SHELL 2 SM,2005269,CDM,270,RC,,,outpatient,,,169.25,84.63,,164.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,152.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,115.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,101.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,149.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,112.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,137.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,155.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,160.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,164.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,110.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,101.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,101.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,152.33,
WALKER FULL SHELL 2 MED,2005270,CDM,270,RC,,,outpatient,,,175.25,87.63,,169.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,157.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,119.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,116.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,141.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,161.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,166.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,169.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,157.73,
WALKER FULL SHELL 2 LG,2005271,CDM,270,RC,,,outpatient,,,174.5,87.25,,169.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,157.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,119.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,104.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,140.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,115.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,141.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,160.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,165.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,169.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,104.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,157.05,
WALKER FULL SHELL 2  XLG,2005272,CDM,270,RC,,,outpatient,,,175.25,87.63,,169.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,157.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,119.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,116.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,141.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,161.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,166.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,169.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,157.73,
KNEE IMMOBILIZER 16'' UNIVERSAL,2005273,CDM,270,RC,,,outpatient,,,119,59.5,,115.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,107.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,81.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,71.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,78.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,96.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,109.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,113.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,115.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,71.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,71.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,107.1,
KNEE IMMOBILIZER 19'' UNIVERSAL,2005274,CDM,270,RC,,,outpatient,,,131,65.5,,127.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,117.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,106.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,120.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,124.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,127.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,78.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117.9,
KNEE IMMOBILIZER 19'' BARIATRIC,2005275,CDM,270,RC,,,outpatient,,,142.5,71.25,,138.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,128.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,97.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,94.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,115.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,131.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,135.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,138.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,92.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,128.25,
KNEE IMMOBILIZER 24'' UNIVERSAL,2005276,CDM,270,RC,,,outpatient,,,166.25,83.13,,161.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,149.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,134.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,152.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,157.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,161.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,149.63,
KNEE BRACE SPORTS HINGED SM,2005277,CDM,270,RC,,,outpatient,,,175.5,87.75,,170.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,157.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,119.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,116.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,142.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,161.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,166.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,170.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,157.95,
KNEE BRACE SPORTS HINGED MED,2005278,CDM,270,RC,,,outpatient,,,175.5,87.75,,170.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,157.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,119.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,116.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,142.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,161.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,166.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,170.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,157.95,
KNEE BRACE SPORTS HINGED LG,2005279,CDM,270,RC,,,outpatient,,,175.5,87.75,,170.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,157.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,119.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,116.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,142.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,161.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,166.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,170.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,157.95,
KNEE BRACE SPORTS HINGED XLG,2005280,CDM,270,RC,,,outpatient,,,175.5,87.75,,170.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,157.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,119.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,116.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,142.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,161.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,166.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,170.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,157.95,
KNEE BRACE SPORTS HINGED  XXLG,2005281,CDM,270,RC,,,outpatient,,,175.5,87.75,,170.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,157.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,119.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,116.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,142.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,161.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,166.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,170.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,157.95,
KNEE BRACE WARRIOR RECOVERY UNIVERSAL,2005282,CDM,270,RC,,,outpatient,,,320,160,,310.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,192,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96,30,,,percent of total billed charges,Pays at 30% of total billed charges,288,90,,,percent of total billed charges,Pays at 90% of total billed charges,288,90,,,percent of total billed charges,Pays at 90% of total billed charges,192,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,218.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,192,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,258.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,258.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,283.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,212.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,259.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,294.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,304,95,,,percent of total billed charges,Pays at 95% of total billed charges,310.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,208,65,,,percent of total billed charges,Pays at 65% of total billed charges,192,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,288,90,,,percent of total billed charges,Pays at 90% of total billed charges,192,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,192,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,288,
SHOULDER IMMOBILIZER W/FOAM STRAP SM,2005283,CDM,270,RC,,,outpatient,,,42.75,21.38,,41.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,39.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,90,
KNEE BRACE WARRIOR II  WRAP AROUND,2005284,CDM,270,RC,,,outpatient,,,402.5,201.25,,390.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,241.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,362.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,362.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,241.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,292.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,274.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,241.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,324.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,324.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,356.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,266.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,326.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,370.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,382.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,390.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,261.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,241.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,241.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,241.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,362.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,241.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,241.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,362.25,
SHOULDER IMMOB-W/STRA LARGE,2005285,CDM,270,RC,,,outpatient,,,42.75,21.38,,41.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,39.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,90,
SHOULDER IMMOB-W/STRA XL,2005286,CDM,270,RC,,,outpatient,,,42.75,21.38,,41.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,39.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,90,
SHOULDER IMMOB-/Standard,2005287,CDM,270,RC,,,outpatient,,,169,84.5,,163.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,152.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,115.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,149.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,112.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,136.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,155.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,160.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,163.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,152.1,
WALKER TRACKER EX MED,2005288,CDM,270,RC,,,outpatient,,,192.75,96.38,,186.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,115.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,173.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,173.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,131.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,115.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,170.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,127.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,156.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,177.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,183.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,186.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,125.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,115.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,115.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,173.48,
WRIST BRACE WARRIOR  RT UNIVERSAL,2005290,CDM,270,RC,,,outpatient,,,75.5,37.75,,73.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,69.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,73.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,90,
WRIST BRACE WARRIOR  LT UNIVERSAL,2005291,CDM,270,RC,,,outpatient,,,75.5,37.75,,73.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,69.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,73.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,90,
WRIST BRACE THUMB WARRIOR  RT UNIVERSAL,2005292,CDM,270,RC,,,outpatient,,,85,42.5,,82.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,51,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,76.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,51,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,68.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,80.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,82.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,51,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,51,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51,90,
WRIST BRACE THUMB WARRIOR  LT UNIVERSAL,2005293,CDM,270,RC,,,outpatient,,,85,42.5,,82.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,51,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,76.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,51,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,68.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,80.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,82.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,51,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,51,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51,90,
WRIST BRACE BOXER WARRIOR  RT UNIVERSAL,2005294,CDM,270,RC,,,outpatient,,,118.25,59.13,,114.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,106.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,80.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,70.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,95.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,104.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,78.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,95.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,108.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,112.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,114.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,70.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,70.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,106.43,
WRIST BRACE BOXER WARRIOR  LT UNIVERSAL,2005295,CDM,270,RC,,,outpatient,,,118.25,59.13,,114.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,106.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,80.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,70.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,95.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,104.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,78.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,95.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,108.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,112.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,114.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,70.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,70.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,106.43,
ELBOW WARRIOR  LT UNIVERSAL,2005296,CDM,270,RC,,,outpatient,,,247.5,123.75,,240.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,148.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,222.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,148.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,168.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,148.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,199.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,219.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,164.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,200.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,227.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,235.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,240.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,160.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,148.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,148.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,148.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,222.75,
ELBOW WARRIOR  RT UNIVERSAL,2005297,CDM,270,RC,,,outpatient,,,247.5,123.75,,240.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,148.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,222.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,148.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,168.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,148.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,199.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,219.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,164.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,200.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,227.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,235.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,240.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,160.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,148.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,148.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,148.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,222.75,
FLIPCUTTER II SHORT 9.5MM,2005298,CDM,272,RC,,,outpatient,,,774.5,387.25,,751.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,697.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,697.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,563.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,528.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,625.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,625.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,686.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,513.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,627.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,712.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,735.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,751.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,503.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,697.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,697.05,
PIVOTPOST PAD,2005299,CDM,272,RC,,,outpatient,,,167.25,83.63,,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.53,
MIXVAC III,2005300,CDM,270,RC,,,outpatient,,,225.75,112.88,,218.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,203.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,154.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,182.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,207.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,214.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,218.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,203.18,
BLADE SAGITAL18.0X2790MM,2005301,CDM,270,RC,,,outpatient,,,121.75,60.88,,118.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,98.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,115.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,118.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,109.58,
BLADE SAGITAL 25.0X27X90MM,2005302,CDM,270,RC,,,outpatient,,,121.75,60.88,,118.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,98.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,115.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,118.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,109.58,
SCREW MICRO  20.0mm,2005303,CDM,272,RC,,,outpatient,,,1481,740.5,,1436.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,888.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,444.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,1332.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,1332.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,888.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1077.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1010.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,888.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1195.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1195.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1312.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,981.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1199.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1362.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,1406.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,1436.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,962.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,888.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,888.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,888.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1332.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,888.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,888.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1332.9,
SUTURE MAXON 4.0 P 12,2005304,CDM,272,RC,,,outpatient,,,2,1,,1.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,1.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,1.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,1.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.2,90,
SUTURE TICRON  SURGIDAC,2005305,CDM,272,RC,,,outpatient,,,13.5,6.75,,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,
TRANS TIB ACL SAWBLADE,2005306,CDM,272,RC,,,outpatient,,,345.75,172.88,,335.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,207.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,311.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,311.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,235.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,207.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,279.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,279.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,306.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,229.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,280.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,318.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,328.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,335.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,224.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,207.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,311.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,207.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,311.18,
SCREW BC 10X30MM,2005307,CDM,278,RC,,,outpatient,,,703.25,351.63,,682.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,632.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,632.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,511.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,479.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,567.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,567.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,623.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,466.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,569.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,646.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,668.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,682.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,457.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,632.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,632.93,
FIBERSTICK #2,2005308,CDM,272,RC,,,outpatient,,,239,119.5,,231.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,143.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,215.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,215.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,143.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,163.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,143.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,192.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,211.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,158.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,193.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,219.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,227.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,231.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,143.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,143.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,143.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,215.1,
SUTURE  POLYSORB 0 UNDYED GS-21,2005309,CDM,272,RC,,,outpatient,,,25.75,12.88,,24.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,23.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.45,90,
SUTURE  POLYSORB 2-0 V20,2005310,CDM,272,RC,,,outpatient,,,28.25,14.13,,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,90,
SUTURE  MONOSOF 8.0 MV 135,2005311,CDM,272,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,90,
SUTURE  SURGIPRO II 6.0 CV-11,2005312,CDM,272,RC,,,outpatient,,,8.75,4.38,,8.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,90,
SUTURE  POLYSORB 3.0-V20,2005313,CDM,272,RC,,,outpatient,,,6.75,3.38,,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,90,
SUTURE MONOSOF 5.0 PC 13,2005314,CDM,272,RC,,,outpatient,,,14.5,7.25,,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,90,
SUTURE MONOSOF6.0 PC 13,2005315,CDM,272,RC,,,outpatient,,,14.75,7.38,,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,90,
PLATE SUTURE RETENTION,2005316,CDM,278,RC,,,outpatient,,,786.75,393.38,,763.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,472.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,708.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,708.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,472.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,572.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,536.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,472.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,635.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,635.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,697.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,521.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,637.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,723.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,747.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,763.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,511.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,472.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,472.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,472.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,708.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,472.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,472.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,708.08,
WITTMAN PATCH,2005317,CDM,278,RC,,,outpatient,,,8101.25,4050.63,,7858.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,4860.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,7291.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,7291.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,4860.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5894.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5529.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4860.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6539.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6539.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7178.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5371.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6562.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7453.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,7696.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,7858.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,5265.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,4860.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4860.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4860.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7291.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,4860.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4860.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,7291.13,
SUTURE  POLYSORB 4.0 V-20,2005318,CDM,272,RC,,,outpatient,,,28.5,14.25,,27.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,90,
RETRACTOR ALEXIS WOUND 11CMTO 17CM,2005319,CDM,272,RC,,,outpatient,,,220,110,,213.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,132,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66,30,,,percent of total billed charges,Pays at 30% of total billed charges,198,90,,,percent of total billed charges,Pays at 90% of total billed charges,198,90,,,percent of total billed charges,Pays at 90% of total billed charges,132,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,150.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,132,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,177.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,194.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,145.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,178.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,202.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,209,95,,,percent of total billed charges,Pays at 95% of total billed charges,213.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,143,65,,,percent of total billed charges,Pays at 65% of total billed charges,132,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198,90,,,percent of total billed charges,Pays at 90% of total billed charges,132,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,132,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,198,
DRESSING DUO SPOT  2,2005321,CDM,270,RC,,,outpatient,,,6.75,3.38,,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,90,
MESH GORE TISSUE PATCH 15CM X 20CM,2005322,CDM,278,RC,,,outpatient,,,1120,560,,1086.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,672,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,336,30,,,percent of total billed charges,Pays at 30% of total billed charges,1008,90,,,percent of total billed charges,Pays at 90% of total billed charges,1008,90,,,percent of total billed charges,Pays at 90% of total billed charges,672,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,814.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,764.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,672,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,904.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,904.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,992.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,742.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,907.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1030.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,1064,95,,,percent of total billed charges,Pays at 95% of total billed charges,1086.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,728,65,,,percent of total billed charges,Pays at 65% of total billed charges,672,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,672,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,672,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1008,90,,,percent of total billed charges,Pays at 90% of total billed charges,672,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,672,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1008,
GORE TEX PATCH 10X15,2005323,CDM,278,RC,,,outpatient,,,2924.75,1462.38,,2837.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,1754.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,877.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,2632.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,2632.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1754.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2128.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1996.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1754.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2360.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2360.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2591.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1939.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2369.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2690.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,2778.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,2837.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,1901.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,1754.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1754.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1754.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2632.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1754.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1754.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2632.28,
OVER TUBE SMALL,2005325,CDM,272,RC,,,outpatient,,,391.25,195.63,,379.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,234.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,352.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,352.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,234.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,284.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,267.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,234.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,315.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,315.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,346.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,259.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,316.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,359.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,371.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,379.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,254.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,234.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,234.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,234.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,352.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,234.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,234.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,352.13,
OVER TUBE LARGE,2005326,CDM,272,RC,,,outpatient,,,391.25,195.63,,379.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,234.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,352.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,352.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,234.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,284.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,267.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,234.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,315.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,315.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,346.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,259.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,316.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,359.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,371.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,379.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,254.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,234.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,234.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,234.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,352.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,234.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,234.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,352.13,
OVER TUBE MED,2005327,CDM,272,RC,,,outpatient,,,391.25,195.63,,379.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,234.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,352.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,352.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,234.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,284.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,267.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,234.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,315.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,315.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,346.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,259.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,316.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,359.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,371.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,379.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,254.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,234.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,234.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,234.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,352.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,234.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,234.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,352.13,
MESH PERIETEX 20,2005328,CDM,278,RC,,,outpatient,,,3242,1621,,3144.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,1945.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2917.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2917.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1945.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2358.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2212.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1945.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2616.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2616.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2872.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2149.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2626.02,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2982.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,3079.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,3144.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,2107.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,1945.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1945.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1945.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2917.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1945.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1945.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2917.8,
DRESSING SOF ROL STERILE 3X4,2005329,CDM,272,RC,,,outpatient,,,5.25,2.63,,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,90,
MESH 7X10 HIATlL GRAFT,2005330,CDM,278,RC,,,outpatient,,,3497.75,1748.88,,3392.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,2098.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3147.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,3147.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,2098.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2544.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2387.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2098.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2823.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2823.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3099.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2319.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2833.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3217.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,3322.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,3392.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,2273.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,2098.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2098.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2098.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3147.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,2098.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2098.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3147.98,
MESH VENTRALEX ST SMALL,2005331,CDM,278,RC,,,outpatient,,,908.25,454.13,,881,97,,,percent of total billed charges,Pays at 97% of total billed charges,544.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,817.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,817.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,544.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,660.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,619.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,544.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,733.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,733.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,804.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,602.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,735.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,835.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,862.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,881,97,,,percent of total billed charges,Pays at 97% of total billed charges,590.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,544.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,544.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,544.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,817.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,544.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,544.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,817.43,
MESH VENTRALEX ST MED,2005332,CDM,278,RC,,,outpatient,,,1092.25,546.13,,1059.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,655.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,983.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,983.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,655.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,794.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,745.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,655.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,881.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,881.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,967.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,724.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,884.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1004.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,1037.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,1059.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,709.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,655.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,655.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,655.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,983.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,655.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,655.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,983.03,
MESH VENTRALEX ST LG,2005333,CDM,278,RC,,,outpatient,,,1387,693.5,,1345.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,832.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1248.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1248.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,832.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1009.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,946.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,832.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1119.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1119.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1229.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,919.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1123.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1276.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,1317.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,1345.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,901.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,832.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,832.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,832.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1248.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,832.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,832.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1248.3,
MESH PHASIX ST 8CM,2005334,CDM,278,RC,,,outpatient,,,3436.25,1718.13,,3333.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,2061.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3092.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3092.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,2061.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2500.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2345.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2061.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2773.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2773.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3044.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2278.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2783.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3161.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,3264.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,3333.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,2233.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,2061.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2061.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2061.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3092.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,2061.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2061.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3092.63,
MESH PHASIX ST 7X10CM,2005335,CDM,278,RC,,,outpatient,,,3497.75,1748.88,,3392.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,2098.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3147.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,3147.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,2098.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2544.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2387.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2098.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2823.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2823.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3099.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2319.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2833.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3217.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,3322.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,3392.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,2273.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,2098.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2098.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2098.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3147.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,2098.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2098.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3147.98,
MESH PHASIX ST13X25CM,2005336,CDM,278,RC,,,outpatient,,,13633.75,6816.88,,13224.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,8180.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,12270.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,12270.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,8180.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9919.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9305.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8180.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11005.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11005.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12080.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9039.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11043.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12543.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,12952.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,13224.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,8861.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,8180.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8180.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8180.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12270.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,8180.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8180.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,12270.38,
MESH ventralight st 4.5 CIRCLE,2005337,CDM,278,RC,,,outpatient,,,989,494.5,,959.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,593.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,890.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,890.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,593.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,719.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,674.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,593.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,798.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,798.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,876.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,655.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,801.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,909.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,939.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,959.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,642.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,593.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,593.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,593.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,890.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,593.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,593.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,890.1,
ARTERY CATH KIT,2005338,CDM,272,RC,,,outpatient,,,41,20.5,,39.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,36.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.6,90,
DRESSING BULKEE 2,2005340,CDM,272,RC,,,outpatient,,,2,1,,1.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,1.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,1.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,1.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.2,90,
BIO PATCH DRESSING,2005341,CDM,272,RC,,,outpatient,,,26.25,13.13,,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,90,
STAPLE EXTRACTOR,2005342,CDM,272,RC,,,outpatient,,,5.75,2.88,,5.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,90,
SKIN STAPLER,2005344,CDM,272,RC,,,outpatient,,,101.48,50.74,,98.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.89,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.44,30,,,percent of total billed charges,Pays at 30% of total billed charges,91.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.89,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.89,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,82.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,93.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.89,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.89,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.89,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.89,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,60.89,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,91.33,
VIDEO LARYNGOSCOPE STANDARD BLADE,2005345,CDM,272,RC,,,outpatient,,,145.25,72.63,,140.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,130.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,99.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,117.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,96.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,133.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.73,
VIDEO LARYNGOSCOPE CHANNELED BLADE,2005346,CDM,272,RC,,,outpatient,,,145.25,72.63,,140.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,130.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,99.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,117.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,96.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,133.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.73,
HEEL LIFT ADJUSTABLE MED,2005347,CDM,272,RC,,,outpatient,,,69.75,34.88,,67.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,62.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,41.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,56.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,64.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,67.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,41.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,41.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.85,90,
CAUTERY/DISP,2005348,CDM,272,RC,,,outpatient,,,35.75,17.88,,34.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,90,
BOUGIE 15FR COUDE TIP,2005349,CDM,272,RC,,,outpatient,,,71.5,35.75,,69.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,57.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,65.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,67.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,90,
RESEVIOR  JACKSON PRATT,2005350,CDM,272,RC,,,outpatient,,,11.5,5.75,,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,90,
DRESSING MEDIHONEY paste,2005351,CDM,272,RC,,,outpatient,,,63,31.5,,61.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,56.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,51.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,57.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,59.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,61.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,37.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.8,90,
AXIOM DRAIN,2005352,CDM,272,RC,,,outpatient,,,108.25,54.13,,105,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,95.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,71.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,87.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,99.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,102.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,105,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,97.43,
ROUND DRAIN 19FR,2005353,CDM,272,RC,,,outpatient,,,107.75,53.88,,104.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,96.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,95.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,71.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,87.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,99.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,102.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,104.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,96.98,
ROUND DRAIN 15FR,2005354,CDM,272,RC,,,outpatient,,,65.5,32.75,,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,53.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,60.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,62.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,90,
SURGICEL 2X3,2005356,CDM,272,RC,,,outpatient,,,103.5,51.75,,100.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,93.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,93.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,70.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,68.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,95.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,98.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,100.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,62.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,93.15,
ALLEYVEN LIFE 10X10,2005357,CDM,272,RC,,,outpatient,,,13.25,6.63,,12.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.95,90,
ALLEYVEN LIFE 12X12,2005358,CDM,272,RC,,,outpatient,,,16.75,8.38,,16.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,15.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.05,90,
ALLEYVEN LIFE 15X15,2005359,CDM,272,RC,,,outpatient,,,22,11,,21.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,19.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,21.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.2,90,
ALLEYVEN LIFE 21X21,2005360,CDM,272,RC,,,outpatient,,,42.5,21.25,,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,39.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.5,90,
ALLEYVEN LIFE HEEL,2005361,CDM,271,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
ALLEYVEN LIFE SACRUM,2005362,CDM,272,RC,,,outpatient,,,40.5,20.25,,39.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,36.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.3,90,
FLANGE 57MM,2005363,CDM,272,RC,,,outpatient,,,30,15,,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9,30,,,percent of total billed charges,Pays at 30% of total billed charges,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,27.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,90,
FLANGE 70MM,2005364,CDM,272,RC,,,outpatient,,,5.5,2.75,,5.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,90,
POUCH 57MM,2005365,CDM,272,RC,,,outpatient,,,11,5.5,,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,90,
POUCH 70MM,2005366,CDM,272,RC,,,outpatient,,,11,5.5,,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,90,
DISP BIPOLAR ADSON,2005367,CDM,272,RC,,,outpatient,,,530.75,265.38,,514.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,318.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,477.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,477.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,318.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,386.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,362.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,318.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,428.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,428.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,470.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,351.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,429.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,488.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,504.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,514.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,344.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,318.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,318.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,318.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,477.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,318.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,318.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,477.68,
COLOSTOMY 2 1/4 FLANGE,2005368,CDM,272,RC,,,outpatient,,,24.75,12.38,,24.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,90,
PESSARY RING W/SUPPORT SZ8,2005369,CDM,272,RC,,,outpatient,,,147.5,73.75,,143.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,132.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,100.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,88.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,97.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,119.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,135.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,140.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,143.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,88.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,88.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,132.75,
MESH 4 X 6,2005370,CDM,278,RC,,,outpatient,,,286,143,,277.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,171.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,257.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,257.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,171.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,195.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,171.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,230.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,230.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,253.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,189.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,231.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,263.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,271.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,277.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,185.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,171.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,257.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,171.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,171.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,257.4,
GAS SAMPLING LINE,2005371,CDM,272,RC,,,outpatient,,,6.75,3.38,,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,90,
ACL FUNCTIOL BRACE B,2005372,CDM,270,RC,,,outpatient,,,1241.5,620.75,,1204.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,372.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,1117.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,1117.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,903.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,847.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1002.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1002.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1100.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,823.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1005.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1142.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,1179.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,1204.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,806.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1117.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1117.35,
ACL FUNCTIOL BRACE  A,2005373,CDM,270,RC,,,outpatient,,,1241.5,620.75,,1204.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,372.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,1117.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,1117.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,903.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,847.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1002.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1002.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1100.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,823.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1005.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1142.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,1179.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,1204.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,806.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1117.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1117.35,
PETELLA BAND XXLG,2005374,CDM,270,RC,,,outpatient,,,119.25,59.63,,115.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,107.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,81.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,96.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,109.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,113.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,115.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,107.33,
ACL KNEE BRACE RIGHT XL,2005375,CDM,270,RC,,,outpatient,,,1241.5,620.75,,1204.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,372.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,1117.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,1117.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,903.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,847.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1002.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1002.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1100.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,823.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1005.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1142.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,1179.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,1204.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,806.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1117.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1117.35,
MESH VENTRALIGHT 6  CIRCLE,2005377,CDM,278,RC,,,outpatient,,,1358.25,679.13,,1317.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,814.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1222.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,1222.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,814.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,988.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,927.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,814.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1096.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1096.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1203.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,900.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1100.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1249.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,1290.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,1317.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,882.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,814.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,814.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,814.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1222.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,814.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,814.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1222.43,
ACL FUNCTIOL BRACE LG,2005379,CDM,270,RC,,,outpatient,,,1241.5,620.75,,1204.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,372.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,1117.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,1117.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,903.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,847.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1002.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1002.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1100.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,823.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1005.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1142.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,1179.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,1204.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,806.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1117.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1117.35,
LMB SOFT CORE /DEV/SPLINT MED,2005380,CDM,270,RC,,,outpatient,,,63.25,31.63,,61.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,56.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,51.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,58.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,60.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,61.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,37.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.95,90,
SMART CAPNO LINE PLUS O2,2005381,CDM,271,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,96.3,
ESOPHAGEAL STETH,2005384,CDM,271,RC,,,outpatient,,,51.75,25.88,,50.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,46.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,35.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,41.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,47.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,49.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,50.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.05,90,
TUBE/T CATT 8FR,2005385,CDM,272,RC,,,outpatient,,,68.25,34.13,,66.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,45.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,55.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,62.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,66.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,90,
TUBE/T CATT 10FRX12,2005386,CDM,272,RC,,,outpatient,,,68.25,34.13,,66.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,45.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,55.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,62.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,66.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,90,
STERI STRIP 1/2 X 2,2005387,CDM,272,RC,,,outpatient,,,4.25,2.13,,4.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,4.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,90,
TUBE/T CATT - 12FR,2005388,CDM,272,RC,,,outpatient,,,68.25,34.13,,66.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,45.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,55.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,62.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,66.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,90,
PATELLA BAND XXL,2005389,CDM,271,RC,,,outpatient,,,115.75,57.88,,112.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,104.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,104.18,
"SUTURE MAXON 40MM GR60,GS24",2005391,CDM,272,RC,,,outpatient,,,28.75,14.38,,27.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,90,
TUBE/T DENVER 16FR,2005392,CDM,272,RC,,,outpatient,,,68.25,34.13,,66.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,45.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,55.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,62.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,66.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,90,
MESH ventralight st HERNIA PATCH,2005393,CDM,278,RC,,,outpatient,,,1799,899.5,,1745.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,1079.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1619.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,1619.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,1079.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1308.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1227.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1079.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1452.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1452.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1594.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1192.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1457.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1655.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,1709.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,1745.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,1169.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,1079.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1079.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1079.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1619.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,1079.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1079.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1619.1,
TUBE/T - DENVER 18FR,2005394,CDM,272,RC,,,outpatient,,,68.25,34.13,,66.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,45.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,55.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,62.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,66.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,90,
TUBESTRADI IONFILTRATION,2005395,CDM,272,RC,,,outpatient,,,54.5,27.25,,52.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,49.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,44.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,50.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,51.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,52.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.7,90,
CHOLANGIOGRAM CATH,2005396,CDM,272,RC,,,outpatient,,,209.5,104.75,,203.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,188.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,188.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,142.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,169.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,185.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,138.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,169.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,192.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,199.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,203.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,136.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,188.55,
ASPIRATION TUBING,2005397,CDM,272,RC,,,outpatient,,,233.5,116.75,,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,214.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,221.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.15,
CANNISTER,2005398,CDM,272,RC,,,outpatient,,,47,23.5,,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,38.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,43.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,90,
TRACHEOTOMY SPEAKING VALVE,2005399,CDM,272,RC,,,outpatient,,,220.25,110.13,,213.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,198.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,150.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,177.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,195.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,146.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,178.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,202.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,209.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,213.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,143.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,198.23,
ACL KNEE BRACE LEFT XL,2005400,CDM,270,RC,,,outpatient,,,1241.5,620.75,,1204.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,372.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,1117.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,1117.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,903.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,847.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1002.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1002.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1100.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,823.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1005.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1142.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,1179.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,1204.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,806.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1117.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1117.35,
SUTURE  POLYSORB 2.0 UNDYED GS-21 POPS,2005401,CDM,272,RC,,,outpatient,,,25.75,12.88,,24.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,23.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.45,90,
EYE PROTECTOR GOGGLES GUARD,2005411,CDM,272,RC,,,outpatient,,,21,10.5,,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,90,
MESH  9,2005412,CDM,278,RC,,,outpatient,,,1236.75,618.38,,1199.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,742.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1113.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,1113.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,742.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,899.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,844.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,742.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,998.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,998.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1095.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,819.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1001.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1137.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,1174.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,1199.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,803.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,742.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,742.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,742.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1113.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,742.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,742.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1113.08,
PESSARY RING W/SUPPORT SZ7,2005413,CDM,272,RC,,,outpatient,,,147.5,73.75,,143.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,132.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,100.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,88.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,97.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,119.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,135.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,140.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,143.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,88.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,88.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,132.75,
TA/GIA LOADING UNIT,2005415,CDM,272,RC,,,outpatient,,,406,203,,393.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,243.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,365.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,365.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,243.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,295.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,277.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,243.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,327.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,327.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,359.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,269.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,328.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,373.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,385.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,393.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,263.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,243.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,365.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,243.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,243.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,365.4,
PEN DRAIN 18X1/2,2005416,CDM,272,RC,,,outpatient,,,28.75,14.38,,27.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,90,
TA 55 MULTIFIRE,2005417,CDM,272,RC,,,outpatient,,,662.75,331.38,,642.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,397.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,596.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,596.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,397.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,482.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,452.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,397.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,534.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,534.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,587.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,439.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,536.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,609.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,629.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,642.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,430.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,397.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,397.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,397.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,596.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,397.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,397.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,596.48,
GUIDE WIRE PEG KIT/peripheral,2005418,CDM,272,RC,,,outpatient,,,914.25,457.13,,886.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,548.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,274.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,822.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,822.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,548.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,665.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,623.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,548.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,737.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,737.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,810.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,606.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,740.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,841.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,868.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,886.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,594.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,548.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,548.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,548.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,822.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,548.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,548.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,822.83,
PEG KIT,2005419,CDM,272,RC,,,outpatient,,,699.75,349.88,,678.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,419.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,629.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,629.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,419.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,509.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,477.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,419.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,564.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,564.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,620.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,463.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,566.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,643.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,664.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,678.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,454.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,419.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,419.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,419.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,629.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,419.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,419.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,629.78,
SUTURE 3-0 P 12 POLYSORB SL-5628,2005420,CDM,272,RC,,,outpatient,,,11.75,5.88,,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,90,
SUTURE PLOYSORB 4-0 P12 SL-5637,2005421,CDM,272,RC,,,outpatient,,,11.75,5.88,,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,90,
SUTURE PLOYSORB 5-0 P12 SL-5636,2005422,CDM,272,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,90,
PESSARY RING/ INCONT. SZ6,2005423,CDM,272,RC,,,outpatient,,,147.5,73.75,,143.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,132.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,100.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,88.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,97.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,119.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,135.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,140.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,143.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,88.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,88.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,132.75,
HUMERAL FRACTURE BRACE LG,2005425,CDM,272,RC,,,outpatient,,,187,93.5,,181.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,168.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,127.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,112.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,165.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,123.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,151.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,172.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,177.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,181.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,112.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,112.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,168.3,
TENSOPLAST 3,2005438,CDM,271,RC,,,outpatient,,,17,8.5,,16.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,90,
DARCO SLIMLINE CAST BOOT SM,2005439,CDM,274,RC,,,outpatient,,,70.25,35.13,,68.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,56.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,64.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,68.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.15,90,
DARCO SLIMLINE CAST BOOT MED,2005440,CDM,274,RC,,,outpatient,,,70.25,35.13,,68.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,56.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,64.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,68.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.15,90,
DARCO SLIMLINE CAST BOOT LG,2005441,CDM,274,RC,,,outpatient,,,70.25,35.13,,68.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,56.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,64.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,68.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.15,90,
DARCO SLIMLINE CAST BOOT   XLG,2005442,CDM,274,RC,,,outpatient,,,70.25,35.13,,68.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,56.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,64.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,68.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.15,90,
DARCO SLIMLINE CAST BOOT PED MED,2005443,CDM,274,RC,,,outpatient,,,70.25,35.13,,68.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,56.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,64.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,68.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.15,90,
DARCO SLIMLINE CAST BOOT PED LG,2005444,CDM,274,RC,,,outpatient,,,70.25,35.13,,68.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,56.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,64.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,68.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.15,90,
SCREW BONE MINI ACUTRAK,2005445,CDM,272,RC,,,outpatient,,,1525.5,762.75,,1479.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,915.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1372.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,1372.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,915.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1109.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1041.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,915.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1231.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1231.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1351.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1011.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1235.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1403.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,1449.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,1479.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,991.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,915.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,915.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,915.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1372.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,915.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,915.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1372.95,
DRILL LONG,2005446,CDM,272,RC,,,outpatient,,,1053.5,526.75,,1021.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,632.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,316.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,948.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,948.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,632.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,766.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,719.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,632.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,850.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,850.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,933.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,698.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,853.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,969.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,1000.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,1021.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,684.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,632.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,632.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,632.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,948.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,632.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,632.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,948.15,
DRILL LONG MINI,2005447,CDM,272,RC,,,outpatient,,,948.75,474.38,,920.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,569.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,284.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,853.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,853.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,569.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,690.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,647.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,569.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,765.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,765.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,840.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,629.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,768.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,872.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,901.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,920.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,616.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,569.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,569.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,569.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,853.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,569.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,569.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,853.88,
GUIDE WIRE,2005448,CDM,272,RC,,,outpatient,,,105.25,52.63,,102.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,71.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,69.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,85.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,96.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,99.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,102.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,94.73,
GUIDE WIRE ST,2005449,CDM,272,RC,,,outpatient,,,105.25,52.63,,102.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,71.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,69.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,85.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,96.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,99.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,102.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,94.73,
ACL KNEE BRACE RIGHT XXL,2005450,CDM,270,RC,,,outpatient,,,1241.5,620.75,,1204.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,372.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,1117.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,1117.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,903.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,847.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1002.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1002.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1100.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,823.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1005.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1142.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,1179.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,1204.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,806.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1117.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1117.35,
BOVIE /PENCIL,2005473,CDM,272,RC,,,outpatient,,,12.25,6.13,,11.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,90,
FISH MEDIUM,2005474,CDM,272,RC,,,outpatient,,,149.5,74.75,,145.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,134.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.55,
FISH LARGE,2005475,CDM,272,RC,,,outpatient,,,225,112.5,,218.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,202.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,153.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,181.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,199.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,182.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,207,92,,,percent of total billed charges,Pays at 92% of total billed charges,213.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,218.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,202.5,
XRAY SPONGES,2005476,CDM,272,RC,,,outpatient,,,28,14,,27.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,90,
NEEDLE TRU-CUT BIOPSY,2005477,CDM,272,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,90,
NEEDLE INTRAOSSEOUS SET,2005479,CDM,272,RC,,,outpatient,,,300,150,,291,97,,,percent of total billed charges,Pays at 97% of total billed charges,180,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90,30,,,percent of total billed charges,Pays at 30% of total billed charges,270,90,,,percent of total billed charges,Pays at 90% of total billed charges,270,90,,,percent of total billed charges,Pays at 90% of total billed charges,180,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,204.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,180,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,242.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,265.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,198.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,243,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,276,92,,,percent of total billed charges,Pays at 92% of total billed charges,285,95,,,percent of total billed charges,Pays at 95% of total billed charges,291,97,,,percent of total billed charges,Pays at 97% of total billed charges,195,65,,,percent of total billed charges,Pays at 65% of total billed charges,180,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,270,90,,,percent of total billed charges,Pays at 90% of total billed charges,180,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,180,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,270,
NEEDLE spil 22ga  7in,2005481,CDM,272,RC,,,outpatient,,,15.25,7.63,,14.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.15,90,
SUPER CIRCUIT,2005482,CDM,271,RC,,,outpatient,,,30.5,15.25,,29.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,27.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.3,90,
NEUROSTIMULATOR A,2005487,CDM,278,RC,,,outpatient,,,22913,11456.5,,22225.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,13747.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9908.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,20621.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,20621.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,13747.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16671.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15638.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13747.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18495.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18495.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20303.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15191.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18559.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21079.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,21767.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,22225.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,14893.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,13747.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13747.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13747.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20621.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,13747.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13747.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,20621.7,
ANTEN,2005488,CDM,272,RC,,,outpatient,,,209.25,104.63,,202.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,125.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,188.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,188.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,142.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,125.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,168.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,185.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,138.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,169.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,192.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,198.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,202.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,136.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,125.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,125.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,188.33,
EXTENSION FOR NEUROSTIMULATOR,2005489,CDM,272,RC,,,outpatient,,,1289.25,644.63,,1250.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,773.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,386.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,1160.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1160.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,773.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,938.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,879.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,773.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1040.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1040.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1142.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,854.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1044.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1186.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,1224.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,1250.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,838.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,773.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,773.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,773.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1160.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,773.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,773.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1160.33,
NEEDLE 20GA 3.5 FORAMEN,2005490,CDM,272,RC,,,outpatient,,,209.5,104.75,,203.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,188.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,188.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,142.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,169.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,185.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,138.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,169.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,192.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,199.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,203.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,136.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,188.55,
NEEDLE 20GA5.0 FORAMEN,2005491,CDM,272,RC,,,outpatient,,,209.5,104.75,,203.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,188.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,188.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,142.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,169.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,185.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,138.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,169.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,192.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,199.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,203.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,136.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,188.55,
TEST STIMULATION BOX,2005492,CDM,272,RC,,,outpatient,,,2070.75,1035.38,,2008.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,1242.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,621.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,1863.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1863.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1242.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1506.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1413.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1242.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1671.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1671.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1834.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1372.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1677.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1905.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,1967.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,2008.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,1345.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,1242.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1242.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1242.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1863.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1242.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1242.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1863.68,
KIT LEAD INTRODUCER,2005493,CDM,272,RC,,,outpatient,,,729.75,364.88,,707.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,437.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,656.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,656.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,437.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,530.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,498.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,437.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,589.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,646.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,483.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,591.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,671.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,693.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,707.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,474.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,437.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,437.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,437.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,656.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,437.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,437.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,656.78,
TINED LEAD A,2005494,CDM,278,RC,,,outpatient,,,7603.5,3801.75,,7375.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,4562.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,360,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,6843.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,6843.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4562.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5532.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5189.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4562.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6137.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6137.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6737.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5041.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6158.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6995.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,7223.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,7375.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,4942.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,4562.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4562.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4562.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6843.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4562.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4562.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,6843.15,
TINED LEAD B,2005495,CDM,278,RC,,,outpatient,,,7603.5,3801.75,,7375.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,4562.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,360,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,6843.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,6843.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4562.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5532.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5189.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4562.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6137.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6137.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6737.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5041.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6158.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6995.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,7223.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,7375.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,4942.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,4562.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4562.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4562.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6843.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4562.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4562.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,6843.15,
TINED LEAD C,2005496,CDM,278,RC,,,outpatient,,,7603.5,3801.75,,7375.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,4562.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,360,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,6843.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,6843.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4562.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5532.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5189.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4562.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6137.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6137.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6737.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5041.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6158.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6995.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,7223.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,7375.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,4942.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,4562.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4562.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4562.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6843.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4562.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4562.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,6843.15,
PNE TEST KIT,2005497,CDM,272,RC,,,outpatient,,,1094.25,547.13,,1061.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,656.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,984.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,984.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,656.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,796.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,746.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,656.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,883.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,883.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,969.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,725.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,886.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1006.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,1039.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,1061.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,711.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,656.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,656.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,656.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,984.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,656.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,656.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,984.83,
PATIENT PROGRAMMER,2005498,CDM,272,RC,,,outpatient,,,3099.25,1549.63,,3006.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,1859.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,929.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,2789.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,2789.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1859.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2255.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2115.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1859.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2501.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2501.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2746.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2054.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2510.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2851.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,2944.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,3006.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,2014.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,1859.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1859.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1859.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2789.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1859.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1859.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2789.33,
NEUROSTIMULATOR B,2005499,CDM,278,RC,,,outpatient,,,28375.25,14187.63,,27523.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,17025.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9908.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,25537.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,25537.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,17025.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20645.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19366.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17025.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22904.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22904.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25143.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18812.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22983.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26105.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,26956.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,27523.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,18443.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,17025.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17025.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17025.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25537.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,17025.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17025.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,25537.73,
WAND RFS,2005500,CDM,272,RC,,,outpatient,,,12.5,6.25,,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,90,
KIT LEAD tined A,2005501,CDM,272,RC,,,outpatient,,,729.75,364.88,,707.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,437.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,656.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,656.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,437.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,530.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,498.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,437.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,589.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,646.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,483.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,591.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,671.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,693.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,707.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,474.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,437.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,437.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,437.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,656.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,437.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,437.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,656.78,
KIT LEAD tined B 28,2005502,CDM,272,RC,,,outpatient,,,8892.25,4446.13,,8625.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,5335.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2667.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,8003.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,8003.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,5335.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6470,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6068.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5335.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7177.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7177.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7879.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5895.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7202.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8180.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,8447.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,8625.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,5779.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,5335.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5335.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5335.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8003.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,5335.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5335.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,8003.03,
KIT LEAD tined C 33,2005503,CDM,272,RC,,,outpatient,,,8892.25,4446.13,,8625.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,5335.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2667.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,8003.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,8003.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,5335.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6470,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6068.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5335.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7177.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7177.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7879.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5895.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7202.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8180.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,8447.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,8625.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,5779.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,5335.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5335.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5335.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8003.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,5335.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5335.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,8003.03,
NEUROSTIMULATOR EXTERL,2005504,CDM,272,RC,,,outpatient,,,1042,521,,1010.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,625.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,312.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,937.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,937.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,625.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,758.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,711.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,625.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,841.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,841.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,923.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,690.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,844.02,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,958.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,989.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,1010.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,677.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,625.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,625.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,625.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,937.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,625.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,625.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,937.8,
TWIST LOCK CABLE 25CM,2005505,CDM,272,RC,,,outpatient,,,209.25,104.63,,202.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,125.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,188.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,188.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,142.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,125.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,168.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,185.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,138.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,169.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,192.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,198.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,202.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,136.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,125.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,125.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,188.33,
STIMULATOR CABLE TEST,2005506,CDM,272,RC,,,outpatient,,,209.5,104.75,,203.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,188.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,188.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,142.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,169.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,185.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,138.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,169.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,192.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,199.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,203.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,136.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,125.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,188.55,
NEROSTIMULATOR II INTERSTIM,2005507,CDM,272,RC,,,outpatient,,,29226.5,14613.25,,28349.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,17535.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8767.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,26303.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,26303.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,17535.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21265.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19947.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17535.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23591.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23591.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25897.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19377.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23673.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26888.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,27765.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,28349.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,18997.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,17535.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17535.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17535.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26303.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,17535.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17535.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,26303.85,
PENCIL/SHEATHS STERILE,2005508,CDM,272,RC,,,outpatient,,,16.25,8.13,,15.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,90,
ELECTROLASE BLUNT TIP/ STERILE,2005509,CDM,272,RC,,,outpatient,,,6.75,3.38,,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,90,
TUBING DOUBLE LUMEN TUBING W/QUICK CONNE,2005510,CDM,272,RC,,,outpatient,,,63.75,31.88,,61.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,57.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,51.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,58.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,60.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,61.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.25,90,
TUBING TUMESCENT KIT,2005511,CDM,272,RC,,,outpatient,,,123,61.5,,119.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,110.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,99.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,113.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,119.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,110.7,
ACCOLADE II SZ 2 127 DEG,2005658,CDM,270,RC,,,outpatient,,,1965.25,982.63,,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1429.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1341.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1586.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1741.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1302.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1591.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1808.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1866.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,1906.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1277.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1768.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1179.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1768.73,
MESH PERIETENE 25X20,2005659,CDM,278,RC,,,outpatient,,,3831.25,1915.63,,3716.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,2298.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3448.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,3448.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,2298.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2787.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2614.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2298.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3092.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3092.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3394.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2540.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3103.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3524.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,3639.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,3716.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,2490.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,2298.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2298.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2298.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3448.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,2298.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2298.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3448.13,
SPEEDBRIDGE SYSW/BIO COMP SWIVELOCK,2005660,CDM,272,RC,,,outpatient,,,3952,1976,,3833.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,2371.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1185.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,3556.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,3556.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2371.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2875.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2697.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2371.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3190.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3190.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3501.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2620.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3201.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3635.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,3754.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,3833.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,2568.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,2371.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2371.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2371.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3556.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2371.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2371.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3556.8,
PERFORMAX EE LEAK LG,2005661,CDM,270,RC,,,outpatient,,,156.5,78.25,,151.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,140.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,93.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,106.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,93.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,138.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,103.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,126.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,143.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,148.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,151.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,93.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,93.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,93.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,140.85,
PERFORMAX EE LEAK  XLG,2005662,CDM,270,RC,,,outpatient,,,225,112.5,,218.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,202.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,153.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,181.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,199.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,182.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,207,92,,,percent of total billed charges,Pays at 92% of total billed charges,213.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,218.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,202.5,
"CONNECT FEP S,AC611 HFNC",2005663,CDM,270,RC,,,outpatient,,,99.25,49.63,,96.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,89.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,80.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,91.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,94.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,96.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,90,
"CONNECT FEP M,AC611 HFNC",2005664,CDM,270,RC,,,outpatient,,,99.25,49.63,,96.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,89.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,80.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,91.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,94.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,96.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,90,
CONNECT FEP L AC611 HFNC,2005665,CDM,270,RC,,,outpatient,,,99.25,49.63,,96.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,89.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,80.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,91.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,94.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,96.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,59.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,90,
CIRCUIT HM C1/T1 W/EXP VAULVE&FLOW,2005666,CDM,270,RC,,,outpatient,,,135.25,67.63,,131.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,121.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,92.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,109.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,124.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,131.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.73,
COAXIAL BREATHING CIRCUIT,2005667,CDM,270,RC,,,outpatient,,,40.75,20.38,,39.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.45,90,
VALVE SET TI/CI/MR1/EXPIRATORY,2005668,CDM,270,RC,,,outpatient,,,40.75,20.38,,39.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.45,90,
NEBULIZING ELBOW SE,2005669,CDM,270,RC,,,outpatient,,,156.5,78.25,,151.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,140.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,93.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,106.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,93.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,138.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,103.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,126.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,143.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,148.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,151.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,93.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,93.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,93.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,140.85,
NEBULIZING ELBOW 2 EE,2005670,CDM,270,RC,,,outpatient,,,107.5,53.75,,104.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,96.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,95.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,71.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,87.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,102.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,104.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,64.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,96.75,
NEEDLE BIOPSY BREAST,2006002,CDM,272,RC,,,outpatient,,,253.5,126.75,,245.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,152.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,228.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,228.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,173.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,152.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,204.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,204.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,224.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,168.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,205.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,233.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,240.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,245.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,152.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,152.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,228.15,
NEEDLE GUIDE TRANSRECTAL,2006003,CDM,272,RC,,,outpatient,,,69.5,34.75,,67.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,56.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,63.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,67.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,90,
NEEDLE BIOPSY  LOC BREAST,2006004,CDM,272,RC,,,outpatient,,,183.25,91.63,,177.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,164.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,125.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,148.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,168.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,174.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,177.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,119.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,109.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,164.93,
NEEDLE BIOPSY MONOPTY,2006005,CDM,272,RC,,,outpatient,,,69.5,34.75,,67.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,56.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,63.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,67.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,90,
NEEDLE BIOPSY MONOPTY 2,2006006,CDM,272,RC,,,outpatient,,,241.25,120.63,,234.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,144.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,217.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,217.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,144.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,175.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,164.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,144.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,194.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,213.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,159.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,195.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,221.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,229.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,234.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,156.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,144.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,217.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,144.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,144.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,217.13,
NEEDLE GUIDE,2006007,CDM,272,RC,,,outpatient,,,94.25,47.13,,91.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,84.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,64.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,62.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,76.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,86.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,89.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,91.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.55,90,
NEEDLE STIMUPLEX 21GA 4'',2006008,CDM,272,RC,,,outpatient,,,56.25,28.13,,54.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,50.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,45.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,51.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,53.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,90,
NEEDLE STIMUPLEX 22GA 2'',2006009,CDM,272,RC,,,outpatient,,,50,25,,48.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,30,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,30,,,percent of total billed charges,Pays at 30% of total billed charges,45,90,,,percent of total billed charges,Pays at 90% of total billed charges,45,90,,,percent of total billed charges,Pays at 90% of total billed charges,30,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,40.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,46,92,,,percent of total billed charges,Pays at 92% of total billed charges,47.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,48.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,30,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45,90,,,percent of total billed charges,Pays at 90% of total billed charges,30,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,30,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30,90,
AMNIHOOK,2006012,CDM,272,RC,,,outpatient,,,6.25,3.13,,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,90,
CORD CLAMP,2006014,CDM,272,RC,,,outpatient,,,6,3,,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,
C-PAP MOISTURE 1 OZ,2006016,CDM,271,RC,,,outpatient,,,24.5,12.25,,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,90,
CONTIGEN,2006017,CDM,272,RC,,,outpatient,,,830.25,415.13,,805.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,498.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,249.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,747.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,747.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,498.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,604.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,566.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,498.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,670.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,670.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,735.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,550.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,672.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,763.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,788.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,805.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,539.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,498.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,498.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,498.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,747.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,498.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,498.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,747.23,
BIO INSTRUMENT BIO PRINCE,2006018,CDM,272,RC,,,outpatient,,,132.5,66.25,,128.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,119.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,90.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,117.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,107.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,121.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,125.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,128.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,119.25,
BIO SITE MARKER,2006019,CDM,272,RC,,,outpatient,,,328.5,164.25,,318.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,197.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,295.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,295.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,197.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,239.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,224.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,197.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,265.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,265.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,291.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,217.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,266.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,302.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,312.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,318.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,197.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,295.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,197.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,197.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,295.65,
TEMNO NEEDLE 18GA,2006020,CDM,272,RC,,,outpatient,,,254,127,,246.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,152.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,228.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,228.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,173.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,152.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,205.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,225.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,168.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,205.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,233.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,241.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,246.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,165.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,152.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,152.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,228.6,
INTRO NEEDLE,2006021,CDM,272,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,90,
DISP CORE BIO INSTRUMENT,2006023,CDM,272,RC,,,outpatient,,,166.5,83.25,,161.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,149.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,99.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,134.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,161.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,99.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,99.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,149.85,
ESOPHOGEAL STENT,2006024,CDM,272,RC,,,outpatient,,,6822.5,3411.25,,6617.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,4093.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2046.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,6140.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,6140.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,4093.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4964.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4656.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4093.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5507.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5507.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6045.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4523.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5526.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6276.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,6481.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,6617.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,4434.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,4093.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4093.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4093.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6140.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,4093.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4093.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,6140.25,
ESOPHOGEAL STENT,2006025,CDM,272,RC,,,outpatient,,,6822.5,3411.25,,6617.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,4093.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2046.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,6140.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,6140.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,4093.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4964.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4656.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4093.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5507.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5507.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6045.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4523.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5526.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6276.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,6481.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,6617.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,4434.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,4093.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4093.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4093.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6140.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,4093.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4093.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,6140.25,
PARACENTESIS KIT ABDOMIN,2006054,CDM,272,RC,,,outpatient,,,151.25,75.63,,146.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,136.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,103.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,122.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,100.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,122.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,139.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,143.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,146.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,136.13,
ACT BIO NEEDLE,2006055,CDM,272,RC,,,outpatient,,,251.25,125.63,,243.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,150.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,226.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,226.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,171.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,150.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,202.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,222.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,166.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,203.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,231.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,238.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,243.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,163.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,150.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,150.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,226.13,
ACT BIO NEEDLE B,2006056,CDM,272,RC,,,outpatient,,,216.75,108.38,,210.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,130.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,195.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,195.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,147.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,130.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,192.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,143.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,175.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,199.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,205.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,210.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,130.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,130.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,195.08,
ACT BIO NEEDLE C,2006057,CDM,272,RC,,,outpatient,,,197.25,98.63,,191.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,177.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,177.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,134.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,159.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,130.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,159.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,181.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,187.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,191.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,128.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,177.53,
UTERINE MANIPULATOR,2006058,CDM,272,RC,,,outpatient,,,182.5,91.25,,177.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,164.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,124.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,161.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,147.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,167.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,173.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,177.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,164.25,
UTERINE MANIPULATOR 7MM,2006059,CDM,272,RC,,,outpatient,,,167.5,83.75,,162.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,111.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,154.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,159.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.75,
UTERINE INJECTOR,2006060,CDM,272,RC,,,outpatient,,,926.25,463.13,,898.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,555.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,277.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,833.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,833.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,555.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,673.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,632.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,555.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,747.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,747.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,820.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,614.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,750.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,852.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,879.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,898.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,602.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,555.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,555.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,555.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,833.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,555.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,555.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,833.63,
UTERINE MANIPULATOR9MM,2006061,CDM,272,RC,,,outpatient,,,188.5,94.25,,182.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,169.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,169.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,128.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,167.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,124.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,152.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,173.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,179.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,182.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,122.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,169.65,
BREAST LESION LOCAL,2006062,CDM,272,RC,,,outpatient,,,203,101.5,,196.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,182.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,138.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,163.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,179.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,134.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,164.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,186.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,192.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,196.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,182.7,
SPIRAL ELECTROS,2006070,CDM,271,RC,,,outpatient,,,23,11.5,,22.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,20.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.8,90,
MECONIUM ASPIRATOR,2006091,CDM,272,RC,,,outpatient,,,18,9,,17.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,90,
INTRA PRESS CATH,2006103,CDM,272,RC,,,outpatient,,,182.5,91.25,,177.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,164.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,124.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,161.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,147.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,167.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,173.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,177.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,164.25,
GAYMAR PADS,2006122,CDM,271,RC,,,outpatient,,,24.5,12.25,,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,90,
HEEL LIFT,2006145,CDM,270,RC,,,outpatient,,,55.25,27.63,,53.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,49.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,44.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,50.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,52.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,53.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.15,90,
B & B SUSPENS/XLG,2006146,CDM,271,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
B & B SUSPENS/MED,2006147,CDM,271,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
B B SUSPENSE LG,2006148,CDM,271,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
B B SUSPENSE SM,2006149,CDM,271,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
ACE BANDAGE 6,2006164,CDM,271,RC,,,outpatient,,,3.75,1.88,,3.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,90,
COMPRILAN 6CM,2006165,CDM,271,RC,,,outpatient,,,23.25,11.63,,22.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,20.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.95,90,
COMPRILAN 8CM,2006167,CDM,271,RC,,,outpatient,,,28,14,,27.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,90,
COMPRILAN 10CM,2006169,CDM,271,RC,,,outpatient,,,32.25,16.13,,31.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,29.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,29.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,30.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,31.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.35,90,
COMPRILAN 12CM,2006171,CDM,271,RC,,,outpatient,,,62.64,31.32,,60.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.58,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.79,30,,,percent of total billed charges,Pays at 30% of total billed charges,56.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.58,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,42.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.58,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,50.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,57.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,59.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,60.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.72,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.58,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.58,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.58,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.58,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,37.58,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.58,90,
ARTIFLEX10CM,2006172,CDM,271,RC,,,outpatient,,,11.75,5.88,,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,90,
ARTIFLEX15CM,2006173,CDM,271,RC,,,outpatient,,,16.25,8.13,,15.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,90,
INFANT COLLAR,2006174,CDM,274,RC,,,outpatient,,,151.5,75.75,,146.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.58,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,136.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,103.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,122.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,100.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,122.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,139.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,143.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,146.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,136.35,
COMPRILAN 10CM x 10CM DOUBLE ROLL,2006175,CDM,271,RC,,,outpatient,,,59.25,29.63,,57.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,53.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,40.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,47.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,39.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,54.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,56.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,57.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.55,90,
PHIL COLLAR/MED,2006176,CDM,274,RC,,,outpatient,,,70,35,,67.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,42,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.58,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,63,90,,,percent of total billed charges,Pays at 90% of total billed charges,63,90,,,percent of total billed charges,Pays at 90% of total billed charges,42,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,56.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,64.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,67.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,42,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63,90,,,percent of total billed charges,Pays at 90% of total billed charges,42,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42,90,
PHIL COLLAR LGE,2006178,CDM,274,RC,,,outpatient,,,70,35,,67.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,42,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.58,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,63,90,,,percent of total billed charges,Pays at 90% of total billed charges,63,90,,,percent of total billed charges,Pays at 90% of total billed charges,42,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,56.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,64.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,67.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,42,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63,90,,,percent of total billed charges,Pays at 90% of total billed charges,42,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42,90,
IMMOBILIZER HEAD ADULT,2006179,CDM,274,RC,,,outpatient,,,43,21.5,,41.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.58,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,38.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,39.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.8,90,
IMMOBILIZER HEAD CHILD,2006180,CDM,274,RC,,,outpatient,,,42.75,21.38,,41.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.58,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,39.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,90,
IMMOBILIZER HEAD INFANT,2006181,CDM,274,RC,,,outpatient,,,42.75,21.38,,41.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.58,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,39.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,90,
SOGRASTRIC TUBE 6FR,2006182,CDM,272,RC,,,outpatient,,,55.5,27.75,,53.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,49.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,44.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,51.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,52.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,53.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,33.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.3,90,
ANTI FUNGAL OINTMENT,2006183,CDM,271,RC,,,outpatient,,,6.75,3.38,,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,90,
KOMPREX 9CMX1CM,2006184,CDM,271,RC,,,outpatient,,,28,14,,27.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,90,
ARTIFLEX6,2006185,CDM,271,RC,,,outpatient,,,12.75,6.38,,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,
COMPRILAN 12CM DOUBLE ROLL,2006186,CDM,271,RC,,,outpatient,,,93.5,46.75,,90.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,84.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,75.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,86.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,88.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,90.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,90,
TRACH TUBE HOLDR THOMAS,2006631,CDM,271,RC,,,outpatient,,,24.75,12.38,,24.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,90,
ARTIFLEX4,2006632,CDM,271,RC,,,outpatient,,,9.25,4.63,,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,90,
SAG SAW BLADE1X3.35X.050,2006633,CDM,272,RC,,,outpatient,,,183,91.5,,177.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,164.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,124.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,148.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,168.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,173.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,177.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,164.7,
SAG SAW BLADE.5X3.35X.05,2006634,CDM,272,RC,,,outpatient,,,183,91.5,,177.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,164.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,124.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,148.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,168.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,173.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,177.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,164.7,
SAG SAW BLADE.24.9x.64x73.8,2006635,CDM,272,RC,,,outpatient,,,176,88,,170.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,116.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,142.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,161.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,170.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,158.4,
SAG SAW BLADE.13.0X.38X34.5,2006636,CDM,272,RC,,,outpatient,,,151.5,75.75,,146.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,136.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,103.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,122.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,100.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,122.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,139.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,143.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,146.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,136.35,
CEMENT FEMORAL REVOLUTION,2006637,CDM,272,RC,,,outpatient,,,214,107,,207.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,128.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,192.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,192.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,146.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,128.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,172.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,189.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,141.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,173.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,196.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,203.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,207.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,128.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,128.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,192.6,
SWIFT SET,2006929,CDM,270,RC,,,outpatient,,,64.25,32.13,,62.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,57.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,52.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,59.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,62.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,38.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.55,90,
MARLEX MESH,2006930,CDM,278,RC,,,outpatient,,,426.75,213.38,,413.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,256.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,384.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,384.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,256.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,310.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,291.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,256.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,344.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,344.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,378.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,282.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,345.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,392.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,405.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,413.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,277.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,256.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,256.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,256.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,384.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,256.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,256.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,384.08,
BOOT MENS SMALL DARCO,2006932,CDM,274,RC,,,outpatient,,,20.75,10.38,,20.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,90,
BOOT MENS MED DARCO,2006933,CDM,274,RC,,,outpatient,,,20.75,10.38,,20.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,90,
BOOT MENS LRG DARCO,2006934,CDM,274,RC,,,outpatient,,,40.75,20.38,,39.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.45,90,
BOOT WOMENS SM DARCO,2006935,CDM,274,RC,,,outpatient,,,40.75,20.38,,39.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.45,90,
BOOT WOMENS MED DARCO,2006936,CDM,274,RC,,,outpatient,,,40.75,20.38,,39.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.45,90,
MASTISOL,2006937,CDM,270,RC,,,outpatient,,,8.75,4.38,,8.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,90,
BOOT MENS X LRG DARCO,2006938,CDM,274,RC,,,outpatient,,,40.75,20.38,,39.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.45,90,
BOOT ROOKE HEEL RISER,2006939,CDM,274,RC,,,outpatient,,,36.75,18.38,,35.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,33.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,33.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,90,
FIBERGLASS CAST TAPE 4,2007025,CDM,271,RC,,,outpatient,,,37.75,18.88,,36.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,33.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,34.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,36.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.65,90,
FIBERGLASS CAST TAPE 2  COLOR,2007026,CDM,271,RC,,,outpatient,,,8.75,4.38,,8.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,90,
FIBERGLASS CAST TAPE 3 INCH,2007027,CDM,271,RC,,,outpatient,,,28.75,14.38,,27.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,90,
FIBERGLASS CAST TAPE 3  COLOR,2007028,CDM,271,RC,,,outpatient,,,10.5,5.25,,10.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,90,
FIBERGLASS CAST TAPE 2 INCH,2007029,CDM,271,RC,,,outpatient,,,23.75,11.88,,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,90,
FIBERGLASS CAST TAPE 4  COLOR,2007030,CDM,271,RC,,,outpatient,,,13.5,6.75,,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,
FIBERGLASS CAST 2'' delta,2007031,CDM,271,RC,,,outpatient,,,7.75,3.88,,7.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.65,90,
FIBERGLASS CAST 3'' delta,2007032,CDM,271,RC,,,outpatient,,,28.5,14.25,,27.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,90,
FIBERGLASS CAST 4'' delta,2007033,CDM,271,RC,,,outpatient,,,32.75,16.38,,31.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,31.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,90,
FIBERGLASS CAST 5'' delta,2007034,CDM,271,RC,,,outpatient,,,32.75,16.38,,31.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,31.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,90,
FIBERGLASS CAST 6'' delta,2007035,CDM,271,RC,,,outpatient,,,32.75,16.38,,31.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,31.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,90,
FIBERGLASS CAST 2'' delta WHITE,2007036,CDM,271,RC,,,outpatient,,,8,4,,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,90,
FIBERGLASS CAST 3'' delta WHITE,2007037,CDM,271,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,
CERV COLLAR -LG,2007038,CDM,274,RC,,,outpatient,,,29.25,14.63,,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.58,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,90,
FIBERGLASS CAST 4'' delta WHITE,2007039,CDM,271,RC,,,outpatient,,,11.25,5.63,,10.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,90,
CERVICAL COLLAR-MED,2007040,CDM,274,RC,,,outpatient,,,21.25,10.63,,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.58,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,90,
CERV COLLAR FOAM XL,2007042,CDM,274,RC,,,outpatient,,,27.75,13.88,,26.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.58,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,90,
KNEE IMBOLIZER MED,2007052,CDM,270,RC,,,outpatient,,,82.5,41.25,,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,
KNEE IMMOBILIZER-UNIV,2007056,CDM,270,RC,,,outpatient,,,79.75,39.88,,77.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.85,90,
FINGER SPLINT 1,2007064,CDM,271,RC,,,outpatient,,,14.75,7.38,,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,90,
FINGER SPLINT 2,2007066,CDM,271,RC,,,outpatient,,,14,7,,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,90,
FINGER SPLINT 3,2007068,CDM,271,RC,,,outpatient,,,14.75,7.38,,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,90,
VEFLOW FOAM CALF GARMENT MED,2007070,CDM,271,RC,,,outpatient,,,38.75,19.38,,37.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,34.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,23.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,31.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,35.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,36.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,23.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.25,90,
VEFLOW XL DISP. CALF CUFF,2007071,CDM,271,RC,,,outpatient,,,42.75,21.38,,41.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,39.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,90,
VEFLOW BARIATRIC DISP. CALF CUFF,2007072,CDM,271,RC,,,outpatient,,,59.75,29.88,,57.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,53.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,40.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,39.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,48.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,54.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,56.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,57.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,35.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.85,90,
HEEL CUP,2007077,CDM,270,RC,,,outpatient,,,35.5,17.75,,34.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,90,
KNEE IMMOBILIZER-SHORT,2007080,CDM,270,RC,,,outpatient,,,64.25,32.13,,62.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,57.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,52.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,59.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,62.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,38.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.55,90,
COLLAR PEDI PHIL,2007081,CDM,272,RC,,,outpatient,,,64.25,32.13,,62.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,57.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,52.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,59.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,62.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,38.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.55,90,
ADULT DEFIB PAD,2007082,CDM,270,RC,,,outpatient,,,84,42,,81.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,75.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,57.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,55.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,68.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,77.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,79.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,81.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.4,90,
PLASTI BELL 1.2,2007083,CDM,272,RC,,,outpatient,,,14.75,7.38,,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,90,
STIFFNECK COLLAR,2007084,CDM,271,RC,,,outpatient,,,78,39,,75.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,70.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,53.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,46.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,51.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,63.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,71.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,74.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,75.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,46.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,46.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.8,90,
SET /NITROGLYC 60 DROP,2007085,CDM,270,RC,,,outpatient,,,61.25,30.63,,59.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,55.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,41.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,36.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,40.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,49.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,56.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,58.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,59.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,36.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,36.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.75,90,
POSEY FOOT ELEVATOR,2007086,CDM,271,RC,,,outpatient,,,56.5,28.25,,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,45.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,51.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,53.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,90,
POUCH DRAIN W/FLG OPNG,2007087,CDM,271,RC,,,outpatient,,,15.25,7.63,,14.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.15,90,
HOSE T THIGH/LGE REG,2007088,CDM,271,RC,,,outpatient,,,21.25,10.63,,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,90,
NO STING  SKIN FILM,2007089,CDM,271,RC,,,outpatient,,,34.5,17.25,,33.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,31.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,32.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.7,90,
T HOSE THIGH/LGE SHT,2007090,CDM,271,RC,,,outpatient,,,34,17,,32.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,31.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,32.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.4,90,
HOSE T THIGH MED REG,2007092,CDM,271,RC,,,outpatient,,,34.5,17.25,,33.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,31.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,32.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.7,90,
LG SHOULDER IMMOBILIZER,2007093,CDM,270,RC,,,outpatient,,,71.25,35.63,,69.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,64.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,57.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,65.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,67.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.75,90,
HOSE T THIGH/MED SHO,2007094,CDM,271,RC,,,outpatient,,,33.75,16.88,,32.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,30.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,31.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,32.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.25,90,
HOSE T THIGH/SM REG,2007096,CDM,271,RC,,,outpatient,,,21.25,10.63,,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,90,
HOSE T THIGH/SM SHOR,2007098,CDM,271,RC,,,outpatient,,,21.25,10.63,,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,90,
STIFFNECK COLLAR ped,2007099,CDM,271,RC,,,outpatient,,,91.75,45.88,,89,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,82.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,62.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,60.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,74.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,84.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,89,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,55.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.05,90,
HOSE T KNEE/XLGE REG,2007100,CDM,271,RC,,,outpatient,,,21.25,10.63,,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,90,
HOSE T KNEE/LGE REG,2007102,CDM,271,RC,,,outpatient,,,15.75,7.88,,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,90,
HOSE T KNEE MED REG,2007104,CDM,271,RC,,,outpatient,,,13.5,6.75,,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,
KNEE BRACE ACL FUNTIOL,2007105,CDM,270,RC,,,outpatient,,,914.75,457.38,,887.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,548.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,274.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,823.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,823.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,548.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,665.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,624.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,548.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,738.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,738.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,810.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,606.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,740.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,841.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,869.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,887.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,594.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,548.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,548.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,548.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,823.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,548.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,548.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,823.28,
HOSE T KNEE/SM REG,2007106,CDM,271,RC,,,outpatient,,,21.25,10.63,,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,90,
PHIL COLLAR SMALL,2007110,CDM,274,RC,,,outpatient,,,52.75,26.38,,51.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.58,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.65,90,
LEG SPLINT/LGE,2007112,CDM,270,RC,,,outpatient,,,80,40,,77.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24,30,,,percent of total billed charges,Pays at 30% of total billed charges,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,76,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52,65,,,percent of total billed charges,Pays at 65% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,90,
KNEE HIGH TED HOSE /MED,2007113,CDM,271,RC,,,outpatient,,,10.75,5.38,,10.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,90,
LEG SPLINT/MED,2007114,CDM,270,RC,,,outpatient,,,80,40,,77.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24,30,,,percent of total billed charges,Pays at 30% of total billed charges,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,76,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52,65,,,percent of total billed charges,Pays at 65% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,90,
KNEE HIGH TED HOSE LARGE,2007115,CDM,271,RC,,,outpatient,,,10.75,5.38,,10.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,90,
LEG SPLINT SMALL,2007116,CDM,270,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,100.58,
CAST BOOT-LG,2007118,CDM,271,RC,,,outpatient,,,39,19.5,,37.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,35.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,23.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,31.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,35.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,37.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,23.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.4,90,
KNEE HIGH TED HOSE/SM,2007119,CDM,271,RC,,,outpatient,,,10.75,5.38,,10.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,90,
CAST BOOT-MED,2007120,CDM,271,RC,,,outpatient,,,34,17,,32.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,31.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,32.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.4,90,
CAST BOOT-SM,2007122,CDM,271,RC,,,outpatient,,,36.5,18.25,,35.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,33.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,90,
SERMINTO BRACE RT HUMERUS,2007124,CDM,270,RC,,,outpatient,,,165.75,82.88,,160.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,149.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,109.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,134.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,152.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,157.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,160.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,107.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,149.18,
CAST BOOT- FEMALE CHILD,2007125,CDM,271,RC,,,outpatient,,,36.5,18.25,,35.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,33.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,90,
CAST BOOT- FEMALE SM,2007126,CDM,271,RC,,,outpatient,,,36.5,18.25,,35.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,33.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,90,
CAST BOOT- FEMALE MED,2007127,CDM,271,RC,,,outpatient,,,36.5,18.25,,35.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,33.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,90,
BINDER ABD UNIVERSAL,2007128,CDM,271,RC,,,outpatient,,,35.75,17.88,,34.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,90,
COMPRESSION PANTS XXL,2007129,CDM,271,RC,,,outpatient,,,206.25,103.13,,200.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,123.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,185.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,185.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,140.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,123.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,166.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,136.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,167.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,189.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,195.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,200.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,134.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,123.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,123.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,185.63,
SLING SWATHE LGE,2007130,CDM,271,RC,,,outpatient,,,41.25,20.63,,40.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,37.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,39.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,24.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,90,
COMPRESSION PANTS XL,2007131,CDM,271,RC,,,outpatient,,,201.5,100.75,,195.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,120.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,181.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,181.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.61,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,137.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,120.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,178.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,133.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,163.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,185.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,191.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,195.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,130.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,120.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,120.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,181.35,
SLING & SWATHE/MED,2007132,CDM,271,RC,,,outpatient,,,41.25,20.63,,40.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,37.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,39.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,24.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,90,
SLING & SWATHE/SMALL,2007133,CDM,271,RC,,,outpatient,,,42,21,,40.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,37.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.02,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,38.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,39.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.2,90,
ARM SLING LARGE,2007134,CDM,271,RC,,,outpatient,,,16.5,8.25,,16.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,90,
SOF-ROL 3,2007135,CDM,271,RC,,,outpatient,,,6,3,,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,
ARM SLING MED,2007136,CDM,271,RC,,,outpatient,,,16.5,8.25,,16.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,90,
ARM SLING SM,2007138,CDM,271,RC,,,outpatient,,,6.5,3.25,,6.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,90,
ARM SLING  X LARGE,2007139,CDM,271,RC,,,outpatient,,,16.5,8.25,,16.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,90,
ARM SLING/INFANT,2007140,CDM,271,RC,,,outpatient,,,30,15,,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9,30,,,percent of total billed charges,Pays at 30% of total billed charges,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,27.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,90,
ARM SLING/CHILD,2007142,CDM,271,RC,,,outpatient,,,18,9,,17.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,90,
CRISS CROSS LUMBO SUPPORT,2007143,CDM,271,RC,,,outpatient,,,152.75,76.38,,148.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,137.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,104.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,91.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,101.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,123.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,140.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,145.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,148.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,91.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,91.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,137.48,
ARM SPLINT-CHILD/RT,2007144,CDM,270,RC,,,outpatient,,,21,10.5,,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,90,
CAST BOOT- FEMALE LARGE,2007145,CDM,271,RC,,,outpatient,,,36.5,18.25,,35.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,33.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,90,
ARM SPLINT-YOUTH/RT,2007146,CDM,270,RC,,,outpatient,,,24.5,12.25,,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,90,
ABDUCTION PILLOW SM,2007147,CDM,271,RC,,,outpatient,,,47,23.5,,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,38.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,43.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,90,
ARM SPLINT-ADULT/RT,2007148,CDM,270,RC,,,outpatient,,,24.5,12.25,,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,90,
ABDUCTION PILLOW MED,2007149,CDM,271,RC,,,outpatient,,,48,24,,46.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,43.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,38.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,44.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,45.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,46.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.8,90,
ARM SPLINT-CHILD/LFT,2007150,CDM,270,RC,,,outpatient,,,24.5,12.25,,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,90,
ABDUCTION PILLOW LARGE,2007151,CDM,271,RC,,,outpatient,,,48.75,24.38,,47.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,43.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,33.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,32.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,39.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,44.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,46.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,47.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,90,
ARM SPLINT-YOUTH/LFT,2007152,CDM,270,RC,,,outpatient,,,24.5,12.25,,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,90,
ARM SPLINT ADULT LEFT,2007154,CDM,270,RC,,,outpatient,,,24.5,12.25,,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,90,
TENNIS ELBOW SPLINT,2007155,CDM,271,RC,,,outpatient,,,43.5,21.75,,42.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,39.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.1,90,
MASON ALLEN SPLNT LG,2007156,CDM,271,RC,,,outpatient,,,61.25,30.63,,59.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,55.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,41.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,36.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,40.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,49.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,56.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,58.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,59.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,36.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,36.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.75,90,
CAST BOOT-MALE EX LRG,2007157,CDM,271,RC,,,outpatient,,,34,17,,32.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,31.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,32.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.4,90,
MASON ALLEN SPLNT/SM,2007158,CDM,271,RC,,,outpatient,,,50.75,25.38,,49.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,41.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,46.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,48.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,49.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,90,
SPLINT-COLLES RT/SM,2007164,CDM,270,RC,,,outpatient,,,22.75,11.38,,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,90,
KNEE SUPPORTMED W/OPEN PATELLA,2007165,CDM,270,RC,,,outpatient,,,35.5,17.75,,34.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,90,
SPLINT COLLES RT MED,2007166,CDM,270,RC,,,outpatient,,,22.75,11.38,,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,90,
KNEE SUPPORTSMALL W/OPEN PATELLA,2007167,CDM,270,RC,,,outpatient,,,35.5,17.75,,34.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,90,
SPLINT-COLLES RT/LGE,2007168,CDM,270,RC,,,outpatient,,,24.25,12.13,,23.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,90,
SPLINT THUMB SM,2007169,CDM,270,RC,,,outpatient,,,135.5,67.75,,131.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,121.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,92.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,109.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,124.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,131.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.95,
SPLINT COLLES LFT SM,2007170,CDM,274,RC,,,outpatient,,,22.75,11.38,,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,90,
SPLINT THUMB MED,2007171,CDM,270,RC,,,outpatient,,,135.5,67.75,,131.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,121.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,92.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,109.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,124.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,131.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.95,
SPLINT-COLLES LFT/ME,2007172,CDM,274,RC,,,outpatient,,,22.75,11.38,,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,90,
SPLINT-COLLES LFT/LG,2007174,CDM,270,RC,,,outpatient,,,22.75,11.38,,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,90,
SPLINT LFT HAND/W ADHESIVE STRAP,2007175,CDM,270,RC,,,outpatient,,,140,70,,135.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42,30,,,percent of total billed charges,Pays at 30% of total billed charges,126,90,,,percent of total billed charges,Pays at 90% of total billed charges,126,90,,,percent of total billed charges,Pays at 90% of total billed charges,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,124.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,113.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,128.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,133,95,,,percent of total billed charges,Pays at 95% of total billed charges,135.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,91,65,,,percent of total billed charges,Pays at 65% of total billed charges,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126,90,,,percent of total billed charges,Pays at 90% of total billed charges,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,126,
CLAVICLE STRAP /MED,2007176,CDM,271,RC,,,outpatient,,,30,15,,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9,30,,,percent of total billed charges,Pays at 30% of total billed charges,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,27.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,90,
BINDER ABD CLINIC,2007177,CDM,271,RC,,,outpatient,,,72.75,36.38,,70.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,65.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,49.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,43.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,48.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,58.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,66.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,69.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,70.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,43.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,43.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.65,90,
CLAVICLE STRAP rt small,2007178,CDM,271,RC,,,outpatient,,,20,10,,19.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,30,,,percent of total billed charges,Pays at 30% of total billed charges,18,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,90,,,percent of total billed charges,Pays at 90% of total billed charges,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,18.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,19,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,13,65,,,percent of total billed charges,Pays at 65% of total billed charges,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,Pays at 90% of total billed charges,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12,90,
KNEE SUPPORTX-LRGL W/OPEN PATELLA,2007179,CDM,270,RC,,,outpatient,,,35.5,17.75,,34.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,90,
CLAVICLE STRAP /ADULT,2007180,CDM,271,RC,,,outpatient,,,30,15,,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9,30,,,percent of total billed charges,Pays at 30% of total billed charges,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,27.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,90,
CALF SLEEVE NEOPRENE  XL,2007181,CDM,271,RC,,,outpatient,,,45.5,22.75,,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,41.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,90,
CALF SLEEVE NEOPRENE  LG,2007182,CDM,271,RC,,,outpatient,,,45.5,22.75,,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,41.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,90,
KNEE SUPPORTX-SM W/OPEN PATELLA,2007183,CDM,270,RC,,,outpatient,,,35.5,17.75,,34.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,90,
KNEE SUPPORT XX-LRG W/OPEN PATELLA,2007184,CDM,270,RC,,,outpatient,,,35.5,17.75,,34.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,90,
KNEE SUPPORT XXX-LRG W/OPEN PATELLA,2007185,CDM,270,RC,,,outpatient,,,35.75,17.88,,34.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,90,
KOMPREX SMALL KIDNEY,2007186,CDM,270,RC,,,outpatient,,,10.5,5.25,,10.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,90,
LUMBAR SUPPORT LRG,2007187,CDM,270,RC,,,outpatient,,,102.75,51.38,,99.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,92.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,70.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,68.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,94.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,97.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,99.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,92.48,
LUMBAR SUPPORT MED,2007188,CDM,270,RC,,,outpatient,,,102.75,51.38,,99.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,92.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,70.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,68.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,94.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,97.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,99.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,92.48,
LUMBAR SUPPORT SM,2007189,CDM,270,RC,,,outpatient,,,102.75,51.38,,99.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,92.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,70.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,68.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,94.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,97.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,99.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,92.48,
LYNX MID SLING,2007190,CDM,272,RC,,,outpatient,,,2073.25,1036.63,,2011.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,1243.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,621.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,1865.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1865.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1243.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1508.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1414.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1243.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1673.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1673.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1837.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1374.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1679.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1907.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,1969.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,2011.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,1347.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,1243.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1243.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1243.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1865.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1243.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1243.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1865.93,
SUPER PUBIC URETH SUPPORT SYSTEM,2007191,CDM,278,RC,,,outpatient,,,3128.5,1564.25,,3034.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,1877.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2815.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2815.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,1877.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2276.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2135.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1877.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2525.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2525.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2772.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2074.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2534.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2878.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,2972.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,3034.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,2033.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,1877.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1877.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1877.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2815.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,1877.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1877.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2815.65,
KNITTED VICRYL MESH,2007192,CDM,272,RC,,,outpatient,,,1334.75,667.38,,1294.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,800.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,1201.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1201.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,800.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,971.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,910.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,800.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1077.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1077.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1182.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,884.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1081.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1227.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,1268.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,1294.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,867.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,800.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,800.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,800.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1201.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,800.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,800.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1201.28,
PCA tubing,2007193,CDM,272,RC,,,outpatient,,,30.25,15.13,,29.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,27.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,27.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.15,90,
HALO URETH SUPPORT SYSTEM,2007194,CDM,272,RC,,,outpatient,,,2332.5,1166.25,,2262.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,1399.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,699.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,2099.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,2099.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1399.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1697.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1591.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1399.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1882.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1882.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2066.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1546.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1889.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2145.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,2215.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,2262.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,1516.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,1399.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1399.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1399.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2099.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1399.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1399.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2099.25,
LAP BAND AP STANDARD,2007195,CDM,272,RC,,,outpatient,,,8669.25,4334.63,,8409.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,5201.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2600.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,7802.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,7802.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5201.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6307.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5916.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5201.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6997.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6997.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7681.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5747.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7022.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7975.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,8235.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,8409.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,5635.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,5201.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5201.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5201.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7802.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5201.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5201.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,7802.33,
LAP BAND AP LARGE,2007196,CDM,272,RC,,,outpatient,,,7963,3981.5,,7724.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,4777.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2388.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,7166.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,7166.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,4777.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5793.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5434.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4777.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6427.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6427.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7056.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5279.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6450.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7325.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,7564.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,7724.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,5175.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,4777.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4777.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4777.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7166.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,4777.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4777.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,7166.7,
LAP BAND ACCESS PORT KIT AP STANDARD,2007197,CDM,272,RC,,,outpatient,,,1549.5,774.75,,1503.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,929.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,464.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,1394.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,1394.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,929.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1127.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1057.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,929.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1250.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1250.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1373.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1027.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1255.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1425.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,1472.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,1503.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,1007.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,929.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,929.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,929.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1394.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,929.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,929.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1394.55,
LAP BAND ACCESS PORT KIT AP LARGE,2007198,CDM,272,RC,,,outpatient,,,1549.5,774.75,,1503.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,929.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,464.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,1394.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,1394.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,929.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1127.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1057.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,929.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1250.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1250.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1373.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1027.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1255.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1425.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,1472.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,1503.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,1007.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,929.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,929.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,929.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1394.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,929.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,929.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1394.55,
LAP BAND HUBER ACCESS NEEDLE,2007199,CDM,278,RC,,,outpatient,,,33,16.5,,32.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,29.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.8,90,
SILS PORT 5MM-15MM,2007200,CDM,272,RC,,,outpatient,,,969.5,484.75,,940.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,581.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,290.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,872.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,872.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,581.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,705.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,661.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,581.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,782.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,782.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,859.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,642.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,785.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,891.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,921.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,940.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,630.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,581.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,581.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,581.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,872.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,581.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,581.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,872.55,
PORT STANDARD LOW PROFILE,2007201,CDM,272,RC,,,outpatient,,,1680,840,,1629.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,1008,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,504,30,,,percent of total billed charges,Pays at 30% of total billed charges,1512,90,,,percent of total billed charges,Pays at 90% of total billed charges,1512,90,,,percent of total billed charges,Pays at 90% of total billed charges,1008,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1222.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1146.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1008,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1356.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1356.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1488.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1113.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1360.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1545.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,1596,95,,,percent of total billed charges,Pays at 95% of total billed charges,1629.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,1092,65,,,percent of total billed charges,Pays at 65% of total billed charges,1008,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1008,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1008,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1512,90,,,percent of total billed charges,Pays at 90% of total billed charges,1008,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1008,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1512,
PORT LARGE LOW PROFILE,2007202,CDM,272,RC,,,outpatient,,,1680,840,,1629.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,1008,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,504,30,,,percent of total billed charges,Pays at 30% of total billed charges,1512,90,,,percent of total billed charges,Pays at 90% of total billed charges,1512,90,,,percent of total billed charges,Pays at 90% of total billed charges,1008,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1222.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1146.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1008,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1356.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1356.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1488.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1113.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1360.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1545.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,1596,95,,,percent of total billed charges,Pays at 95% of total billed charges,1629.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,1092,65,,,percent of total billed charges,Pays at 65% of total billed charges,1008,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1008,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1008,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1512,90,,,percent of total billed charges,Pays at 90% of total billed charges,1008,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1008,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1512,
PORT STANDARD FLAT,2007203,CDM,272,RC,,,outpatient,,,1953.5,976.75,,1894.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,1172.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,586.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,1758.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,1758.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,1172.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1421.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1333.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1172.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1576.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1576.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1731,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1295.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1582.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1797.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,1855.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,1894.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,1269.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,1172.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1172.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1172.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1758.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,1172.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1172.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1758.15,
SUCTION IRRIGATOR DISP,2007205,CDM,272,RC,,,outpatient,,,207.25,103.63,,201.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,186.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,186.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,124.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,141.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,124.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,167.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,183.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,137.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,167.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,190.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,196.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,201.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,134.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,124.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,124.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,124.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,186.53,
FINGER CONTROL MITT,2007206,CDM,271,RC,,,outpatient,,,66,33,,64.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,59.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,45.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,39.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,53.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,53.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,60.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,62.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,64.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,39.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,39.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,
INSULFFLATOR TUBE SET,2007208,CDM,272,RC,,,outpatient,,,18,9,,17.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,90,
PATELLAR FULL LENTH STABILIZER,2007211,CDM,271,RC,,,outpatient,,,201,100.5,,194.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,180.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,180.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,137.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,178.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,133.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,162.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,184.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,190.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,194.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,130.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,180.9,
TRAY PICC 6F X 55CM X 80CM WIRE,2007212,CDM,272,RC,,,outpatient,,,393,196.5,,381.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,235.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,353.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,353.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,235.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,285.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,268.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,235.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,317.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,317.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,348.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,260.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,318.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,361.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,373.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,381.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,255.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,235.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,353.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,235.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,235.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,353.7,
PORT LARGE FLAT,2007213,CDM,272,RC,,,outpatient,,,1680,840,,1629.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,1008,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,504,30,,,percent of total billed charges,Pays at 30% of total billed charges,1512,90,,,percent of total billed charges,Pays at 90% of total billed charges,1512,90,,,percent of total billed charges,Pays at 90% of total billed charges,1008,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1222.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1146.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1008,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1356.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1356.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1488.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1113.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1360.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1545.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,1596,95,,,percent of total billed charges,Pays at 95% of total billed charges,1629.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,1092,65,,,percent of total billed charges,Pays at 65% of total billed charges,1008,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1008,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1008,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1512,90,,,percent of total billed charges,Pays at 90% of total billed charges,1008,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1008,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1512,
TROCAR 5MM-8MM,2007214,CDM,272,RC,,,outpatient,,,55.25,27.63,,53.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,49.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,44.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,50.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,52.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,53.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.15,90,
INSULFFLATOR  HEAT TUBE SET,2007215,CDM,272,RC,,,outpatient,,,157,78.5,,152.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.3,
PORT BLUNT,2007216,CDM,272,RC,,,outpatient,,,146,73,,141.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,131.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,99.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,87.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,117.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,129.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,96.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,118.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,134.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,138.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,141.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,87.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,87.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,131.4,
V2 PORT BLUNT5MM,2007217,CDM,272,RC,,,outpatient,,,204.5,102.25,,198.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,122.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,184.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,184.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,122.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,139.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,122.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,165.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,181.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,135.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,165.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,188.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,194.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,198.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,132.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,122.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,122.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,122.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,184.05,
V2 PORT BLUNT12MM,2007218,CDM,272,RC,,,outpatient,,,204.5,102.25,,198.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,122.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,184.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,184.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,122.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,139.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,122.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,165.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,181.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,135.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,165.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,188.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,194.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,198.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,132.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,122.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,122.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,122.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,184.05,
5 mm BLUNT PORT OBTURATOR,2007219,CDM,272,RC,,,outpatient,,,149.75,74.88,,145.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,134.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,89.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.78,
PORT BLADED 5mm,2007223,CDM,272,RC,,,outpatient,,,159.25,79.63,,154.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,143.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,143.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,108.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,105.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,128.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,146.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,151.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,154.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,143.33,
CAST WALKER MEDIUM,2007224,CDM,271,RC,,,outpatient,,,54.25,27.13,,52.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,48.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,43.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,49.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,51.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,52.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.55,90,
SILS PORT 5MM-12MM,2007225,CDM,272,RC,,,outpatient,,,919,459.5,,891.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,551.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,275.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,827.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,827.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,551.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,668.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,627.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,551.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,741.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,741.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,814.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,609.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,744.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,845.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,873.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,891.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,597.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,551.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,551.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,551.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,827.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,551.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,551.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,827.1,
CAST WALKER SMALL,2007226,CDM,271,RC,,,outpatient,,,51.25,25.63,,49.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,46.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,41.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,47.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,48.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,49.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,30.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,30.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.75,90,
GASTRI SAIL,2007227,CDM,272,RC,,,outpatient,,,716.25,358.13,,694.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,429.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,644.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,644.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,429.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,521.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,488.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,429.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,578.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,578.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,634.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,474.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,580.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,658.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,680.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,694.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,465.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,429.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,429.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,429.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,644.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,429.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,429.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,644.63,
CAST WALKER LARGE,2007228,CDM,271,RC,,,outpatient,,,54.25,27.13,,52.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,48.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,43.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,49.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,51.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,52.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.55,90,
ENDO CATCH POUCH,2007229,CDM,272,RC,,,outpatient,,,356.5,178.25,,345.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,320.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,243.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,213.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,315.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,236.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,288.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,327.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,338.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,345.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,231.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,213.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,213.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,320.85,
DRAIGE POUCH COOK,2007230,CDM,272,RC,,,outpatient,,,138.5,69.25,,134.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,124.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,124.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,94.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,111.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,122.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,112.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,127.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,131.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,134.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,83.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,124.65,
ENDO CATCH POUCH,2007231,CDM,272,RC,,,outpatient,,,460.75,230.38,,446.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,276.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,414.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,414.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,276.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,335.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,314.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,276.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,371.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,371.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,408.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,305.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,373.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,423.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,437.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,446.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,299.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,276.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,276.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,276.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,414.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,276.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,276.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,414.68,
TRAY BIOPSY,2007233,CDM,272,RC,,,outpatient,,,42.5,21.25,,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,39.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.5,90,
LUMBAR SUPPORT X-LRG,2007234,CDM,270,RC,,,outpatient,,,102.75,51.38,,99.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,92.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,70.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,68.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,94.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,97.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,99.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,92.48,
LUMBAR SUPPORT XX-LRG,2007235,CDM,270,RC,,,outpatient,,,102.75,51.38,,99.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,92.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,70.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,68.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,94.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,97.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,99.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,92.48,
LUMBAR SUPPORT XXX-LRG,2007236,CDM,270,RC,,,outpatient,,,102.75,51.38,,99.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,92.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,70.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,68.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,94.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,97.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,99.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,92.48,
MATERNITY BELT LRG,2007237,CDM,270,RC,,,outpatient,,,111.5,55.75,,108.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,100.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,73.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,105.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,100.35,
MATERNITY BELT MED,2007238,CDM,270,RC,,,outpatient,,,111.5,55.75,,108.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,100.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,73.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,105.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,100.35,
MATERNITY BELT SM,2007239,CDM,270,RC,,,outpatient,,,111.5,55.75,,108.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,100.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,73.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,105.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,100.35,
MATERNITY BELT X-LRG,2007240,CDM,270,RC,,,outpatient,,,111.5,55.75,,108.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,100.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,73.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,105.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,66.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,100.35,
SI BELTS LRG - X LRG,2007241,CDM,270,RC,,,outpatient,,,133.5,66.75,,129.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,120.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,80.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,88.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,108.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,122.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,126.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,129.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,80.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,80.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,120.15,
SI BELTS SM-MED,2007242,CDM,270,RC,,,outpatient,,,133.5,66.75,,129.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,120.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,80.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,88.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,108.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,122.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,126.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,129.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,80.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,80.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,120.15,
OVER THE DOOR TRACTION,2007243,CDM,270,RC,,,outpatient,,,121.75,60.88,,118.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,98.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,115.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,118.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,109.58,
BANDAGE GAUZE TRANSELAST 6CMX4M,2007244,CDM,270,RC,,,outpatient,,,5.75,2.88,,5.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,90,
1&2 ESTIM WIRES,2007245,CDM,270,RC,,,outpatient,,,119.25,59.63,,115.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,107.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,81.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,96.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,109.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,113.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,115.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,107.33,
3&4 ESTIM WIRES,2007246,CDM,270,RC,,,outpatient,,,119.25,59.63,,115.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,107.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,81.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,96.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,109.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,113.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,115.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,107.33,
SAUNDERS CERVICAL TRACTION,2007247,CDM,270,RC,,,outpatient,,,1177,588.5,,1141.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,706.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,353.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,1059.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1059.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,706.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,856.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,803.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,706.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,950.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,950.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1042.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,780.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,953.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1082.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,1118.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,1141.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,765.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,706.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,706.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,706.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1059.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,706.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,706.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1059.3,
SAUNDERS LUMBAR TRACTION,2007248,CDM,270,RC,,,outpatient,,,1437.75,718.88,,1394.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,862.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,431.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,1293.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,1293.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,862.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1046.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,981.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,862.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1160.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1160.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1273.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,953.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1164.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1322.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,1365.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,1394.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,934.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,862.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,862.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,862.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1293.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,862.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,862.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1293.98,
CELLO 4,2007249,CDM,270,RC,,,outpatient,,,20,10,,19.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,30,,,percent of total billed charges,Pays at 30% of total billed charges,18,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,90,,,percent of total billed charges,Pays at 90% of total billed charges,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,18.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,19,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,13,65,,,percent of total billed charges,Pays at 65% of total billed charges,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,Pays at 90% of total billed charges,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12,90,
CELLO 6,2007250,CDM,270,RC,,,outpatient,,,26.25,13.13,,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,90,
KNEE SUPPORT LRGL W/OPEN PATELLA,2007251,CDM,270,RC,,,outpatient,,,35.5,17.75,,34.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,90,
ISOBAND 8X5.5,2007274,CDM,271,RC,,,outpatient,,,47.75,23.88,,46.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,42.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,38.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,43.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,45.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,46.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.65,90,
PORT FIOS Z THREAD,2007275,CDM,272,RC,,,outpatient,,,152.25,76.13,,147.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,137.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,103.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,122.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,100.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,123.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,140.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,144.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,147.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,137.03,
BANDAGE COMPERM 3,2007276,CDM,271,RC,,,outpatient,,,51.5,25.75,,49.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,46.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,35.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,41.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,47.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,48.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,49.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.9,90,
BANDAGE COMPERM 5,2007277,CDM,271,RC,,,outpatient,,,120.25,60.13,,116.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.23,
BANDAGE COMPERM 7,2007278,CDM,271,RC,,,outpatient,,,172.5,86.25,,167.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,155.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,117.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,139.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,158.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,163.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,167.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,155.25,
BANDAGE DOUBLE ACE WRAP 6,2007279,CDM,271,RC,,,outpatient,,,26,13,,25.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,23.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.6,90,
SPLINT WRIST/THUMB,2007773,CDM,270,RC,,,outpatient,,,135.5,67.75,,131.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,121.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,92.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,109.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,124.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,131.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.95,
SPLINT WRIST/THUMB,2007775,CDM,270,RC,,,outpatient,,,135.5,67.75,,131.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,121.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,92.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,109.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,124.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,131.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,81.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.95,
SPLINT W/F UNIVERSAL RT,2007776,CDM,270,RC,,,outpatient,,,47,23.5,,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,38.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,43.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,90,
SPLINT W/F UNIVERSAL lT,2007777,CDM,270,RC,,,outpatient,,,47,23.5,,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,38.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,43.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,90,
GALVESTON SPLINT SMALL,2007779,CDM,271,RC,,,outpatient,,,254,127,,246.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,152.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,228.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,228.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,173.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,152.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,205.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,225.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,168.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,205.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,233.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,241.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,246.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,165.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,152.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,152.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,228.6,
FOOT ORTHOSIS EZE ROCKER XL,2007780,CDM,270,RC,,,outpatient,,,56.5,28.25,,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,45.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,51.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,53.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,90,
TIGHTROPE ABS IMPLANT SYSTEM 14MM,2007781,CDM,278,RC,,,outpatient,,,1355.5,677.75,,1314.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,813.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,406.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,1219.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,1219.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,813.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,986.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,925.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,813.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1094.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1094.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1201.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,898.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1097.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1247.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,1287.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,1314.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,881.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,813.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,813.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,813.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1219.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,813.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,813.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1219.95,
RAPID PORT ACCESS PORT KIT,2007782,CDM,272,RC,,,outpatient,,,1908.75,954.38,,1851.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,1145.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,572.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,1717.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,1717.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1388.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1302.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1145.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1540.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1540.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1691.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1265.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1546.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1756.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,1813.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,1851.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,1240.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,1145.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1717.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1145.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1717.88,
SUTURESOFSILK 0 BLACK GS-834,2007783,CDM,272,RC,,,outpatient,,,5,2.5,,4.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,4.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,90,
SUCT CANNISTER1200ML,2008014,CDM,271,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,
ARTHROSCOPIC IRRIG SET,2008021,CDM,272,RC,,,outpatient,,,24.5,12.25,,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,90,
OVAL BUR,2008093,CDM,270,RC,,,outpatient,,,87.25,43.63,,84.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,78.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,57.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,70.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,82.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,84.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,52.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.35,90,
SKIN GRAFT KNIFE BLADE,2008096,CDM,272,RC,,,outpatient,,,88.5,44.25,,85.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,79.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,53.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,81.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,84.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,53.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,53.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.1,90,
SURGILAV IRR SYSTEM,2008097,CDM,272,RC,,,outpatient,,,771,385.5,,747.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,462.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,231.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,693.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,693.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,462.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,560.98,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,526.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,462.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,622.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,622.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,683.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,511.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,624.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,709.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,732.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,747.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,501.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,462.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,462.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,462.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,693.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,462.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,462.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,693.9,
CYSTO/BLADDER IRR SET,2008100,CDM,272,RC,,,outpatient,,,16.75,8.38,,16.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,15.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.05,90,
TROCAR CORE 5MM,2008110,CDM,272,RC,,,outpatient,,,90,45,,87.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27,30,,,percent of total billed charges,Pays at 30% of total billed charges,81,90,,,percent of total billed charges,Pays at 90% of total billed charges,81,90,,,percent of total billed charges,Pays at 90% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,72.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,82.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,85.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,87.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,Pays at 90% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54,90,
TROCAR CORE 12MM SHORT,2008111,CDM,270,RC,,,outpatient,,,459.5,229.75,,445.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,275.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,413.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,413.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,275.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,334.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,313.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,275.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,370.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,407.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,304.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,372.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,422.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,436.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,445.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,298.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,275.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,275.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,275.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,413.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,275.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,275.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,413.55,
TROCAR CORE 8MM,2008112,CDM,270,RC,,,outpatient,,,242.75,121.38,,235.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,145.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,218.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,218.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,145.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,165.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,145.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,195.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,215.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,160.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,196.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,223.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,230.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,235.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,157.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,145.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,145.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,145.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,218.48,
TROCAR CORE 5MM LONG,2008113,CDM,270,RC,,,outpatient,,,93.5,46.75,,90.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,84.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,75.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,86.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,88.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,90.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,90,
SRE POLYPECTOMY LG,2008114,CDM,272,RC,,,outpatient,,,46.5,23.25,,45.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,41.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,37.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,42.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.9,90,
SRE POLYPECTOMY MED,2008115,CDM,272,RC,,,outpatient,,,48,24,,46.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,43.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,38.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,44.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,45.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,46.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.8,90,
TROCAR CORE12MM LONG,2008116,CDM,270,RC,,,outpatient,,,183,91.5,,177.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,164.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,124.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,148.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,168.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,173.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,177.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,164.7,
TUBING SET FLOSTEADY DISP,2008117,CDM,270,RC,,,outpatient,,,260.25,130.13,,252.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,156.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,234.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,234.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,156.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,189.36,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,177.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,156.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,210.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,230.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,172.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,210.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,239.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,247.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,252.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,169.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,156.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,234.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,156.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,156.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,234.23,
RESECTOR CUTTER FORMULA 4.0,2008118,CDM,270,RC,,,outpatient,,,238,119,,230.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,142.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,214.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,214.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,162.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,142.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,192.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,210.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,157.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,192.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,218.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,226.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,230.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,154.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,142.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,142.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,214.2,
RESECTOR CUTTER FORMULA 5.0,2008119,CDM,270,RC,,,outpatient,,,231.75,115.88,,224.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,208.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,208.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,158.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,139.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,187.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,205.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,153.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,187.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,213.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,220.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,224.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,150.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,139.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,139.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,208.58,
TOMCAT CUTTER FORMULA 4.0,2008120,CDM,270,RC,,,outpatient,,,238,119,,230.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,142.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,214.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,214.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,162.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,142.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,192.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,210.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,157.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,192.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,218.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,226.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,230.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,154.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,142.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,142.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,214.2,
TOMCAT CUTTER FORMULA 5.0,2008121,CDM,270,RC,,,outpatient,,,231.5,115.75,,224.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,138.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,208.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,208.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,138.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,158,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,138.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,186.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,205.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,153.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,187.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,212.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,219.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,224.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,150.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,138.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,138.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,138.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,208.35,
TOMCAT ANGLED CUTTER FORMULA 4.5,2008122,CDM,270,RC,,,outpatient,,,136.75,68.38,,132.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,123.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,90.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,110.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,125.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,129.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,132.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.08,
SSERFAS ENERGY SUPER 90-S,2008123,CDM,270,RC,,,outpatient,,,437.25,218.63,,424.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,262.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,393.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,393.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,262.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,318.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,298.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,262.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,352.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,352.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,387.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,289.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,354.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,402.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,415.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,424.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,284.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,262.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,393.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,262.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,262.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,393.53,
TROCAR  12MM,2008125,CDM,270,RC,,,outpatient,,,232.5,116.25,,225.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,209.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,158.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,139.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,187.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,188.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,213.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,220.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,225.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,139.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,139.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,209.25,
TROCAR  12MM,2008126,CDM,270,RC,,,outpatient,,,232.25,116.13,,225.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,209.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,158.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,187.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,205.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,153.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,188.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,213.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,220.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,225.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,150.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,139.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,209.03,
3.5MMAGGRESSIVE PLUS,2008127,CDM,270,RC,,,outpatient,,,237.75,118.88,,230.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,213.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,162.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,191.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,191.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,210.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,157.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,192.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,218.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,225.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,230.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,154.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,213.98,
4.0MM ANGLED TOMCAT,2008128,CDM,270,RC,,,outpatient,,,132.5,66.25,,128.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,119.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,90.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,117.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,107.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,121.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,125.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,128.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,119.25,
ORVIL 25,2008129,CDM,272,RC,,,outpatient,,,225,112.5,,218.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,202.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,153.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,181.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,199.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,182.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,207,92,,,percent of total billed charges,Pays at 92% of total billed charges,213.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,218.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,202.5,
ORVIL STAPLER 3.5MM,2008130,CDM,272,RC,,,outpatient,,,2428.25,1214.13,,2355.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,1456.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,728.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,2185.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,2185.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,1456.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1766.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1657.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1456.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1960.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1960.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2151.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1609.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1966.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2233.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,2306.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,2355.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,1578.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,1456.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1456.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1456.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2185.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,1456.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1456.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2185.43,
TOMCAT ANGLED CUTTER FORMULA 4.0,2008131,CDM,270,RC,,,outpatient,,,136.75,68.38,,132.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,123.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,90.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,110.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,125.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,129.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,132.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.08,
ORVIL 21,2008132,CDM,272,RC,,,outpatient,,,208.5,104.25,,202.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,187.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,142.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,168.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,184.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,138.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,168.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,191.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,198.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,202.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,187.65,
ORVIL STAPLER 3.5MM 21,2008133,CDM,272,RC,,,outpatient,,,822,411,,797.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,493.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,246.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,739.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,739.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,493.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,598.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,561.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,493.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,663.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,663.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,728.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,544.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,665.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,756.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,780.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,797.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,534.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,493.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,493.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,493.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,739.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,493.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,493.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,739.8,
PRE CUT  ORTHO GLASS 2'',2008139,CDM,270,RC,,,outpatient,,,23.5,11.75,,22.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,21.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.1,90,
PRE CUT  ORTHO GLASS 4,2008140,CDM,270,RC,,,outpatient,,,20.5,10.25,,19.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,18.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,18.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.3,90,
PRE CUT  ORTHO GLASS 3,2008141,CDM,270,RC,,,outpatient,,,15.75,7.88,,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,90,
PRE CUT  ORTHO GLASS 5,2008142,CDM,270,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
TROCAR BALLOON 12MM,2008143,CDM,272,RC,,,outpatient,,,195,97.5,,189.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,175.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,175.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,133.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,157.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,172.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,129.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,157.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,179.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,185.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,189.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,126.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,175.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,175.5,
OXYGEN TENT CANOPY,2008825,CDM,271,RC,,,outpatient,,,37.75,18.88,,36.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,33.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,34.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,36.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.65,90,
BERMAN ORAL AIRWAY 80MM,2008873,CDM,272,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
DRESSING ALGITE,2008881,CDM,272,RC,,,outpatient,,,41.75,20.88,,40.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,38.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,39.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.05,90,
GUIDE WIRE,2008890,CDM,278,RC,,,outpatient,,,389.25,194.63,,377.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,233.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.78,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,350.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,350.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,233.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,283.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,265.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,233.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,314.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,314.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,344.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,258.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,315.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,358.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,369.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,377.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,253.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,233.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,233.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,233.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,350.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,233.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,233.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,350.33,
DRESSING COMPOSITE,2008891,CDM,272,RC,,,outpatient,,,7,3.5,,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,90,
DRESSING AQUACELL,2008892,CDM,272,RC,,,outpatient,,,12,6,,11.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,
DRESSING AQUACELL SILVER,2008893,CDM,272,RC,,,outpatient,,,48.25,24.13,,46.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,43.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,39.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,44.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,45.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,46.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.95,90,
FORCEPS ALLIGATER,2008894,CDM,272,RC,,,outpatient,,,721.75,360.88,,700.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,433.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,216.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,649.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,649.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,433.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,525.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,492.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,433.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,582.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,582.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,639.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,478.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,584.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,664.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,685.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,700.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,469.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,433.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,433.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,433.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,649.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,433.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,433.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,649.58,
FORCEPS CUP BX,2008895,CDM,272,RC,,,outpatient,,,808,404,,783.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,484.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,727.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,727.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,484.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,587.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,551.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,484.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,652.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,652.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,715.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,535.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,654.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,743.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,767.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,783.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,525.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,484.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,484.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,484.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,727.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,484.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,484.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,727.2,
GUIDE WIRE CRE BALLOON  A,2008896,CDM,272,RC,,,outpatient,,,779.25,389.63,,755.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,467.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,233.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,701.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,701.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,467.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,566.98,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,531.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,467.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,629.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,629.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,690.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,516.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,631.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,716.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,740.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,755.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,506.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,467.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,467.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,467.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,701.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,467.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,467.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,701.33,
GUIDE WIRE CRE   BALLON B,2008897,CDM,272,RC,,,outpatient,,,779.25,389.63,,755.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,467.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,233.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,701.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,701.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,467.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,566.98,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,531.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,467.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,629.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,629.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,690.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,516.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,631.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,716.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,740.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,755.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,506.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,467.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,467.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,467.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,701.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,467.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,467.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,701.33,
GUIDE WIRE CRE   BALLON C,2008898,CDM,272,RC,,,outpatient,,,325.75,162.88,,315.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,195.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,293.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,293.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,195.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,237.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,222.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,195.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,262.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,288.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,215.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,263.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,299.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,309.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,315.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,211.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,195.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,293.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,195.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,195.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,293.18,
GUIDE WIRE CRE   BALLON D,2008899,CDM,272,RC,,,outpatient,,,325.25,162.63,,315.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,195.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,292.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,292.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,195.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,236.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,221.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,195.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,262.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,288.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,215.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,263.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,299.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,308.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,315.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,211.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,195.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,292.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,195.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,195.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,292.73,
SYRINGE LOADING,2009001,CDM,272,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
GUIDE WIRE .038X.80CM,2009003,CDM,272,RC,,,outpatient,,,174.5,87.25,,169.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,157.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,119.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,104.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,140.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,115.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,141.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,160.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,165.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,169.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,104.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,157.05,
DI0LATER 7 FR,2009004,CDM,272,RC,,,outpatient,,,92.75,46.38,,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,75.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,88.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,90,
DI0LATER 8 FR,2009005,CDM,272,RC,,,outpatient,,,92.75,46.38,,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,75.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,88.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,90,
DI0LATER 9 FR,2009006,CDM,272,RC,,,outpatient,,,92.75,46.38,,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,75.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,88.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,90,
synthes screw 2.7x25mm,2009007,CDM,270,RC,,,outpatient,,,198.75,99.38,,192.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,119.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,178.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,178.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.61,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,135.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,119.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,176.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,131.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,160.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,182.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,188.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,192.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,129.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,119.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,119.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,178.88,
DRILL BIT BRASSELERS 2.5,2009008,CDM,270,RC,,,outpatient,,,115.25,57.63,,111.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.73,
DRILL BIT BRASSELERS 2.0,2009009,CDM,270,RC,,,outpatient,,,125.5,62.75,,121.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,112.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,85.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,75.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,111.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,83.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,101.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,115.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,119.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,121.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,75.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,75.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,112.95,
K WIRE,2009010,CDM,272,RC,,,outpatient,,,13.5,6.75,,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,
OVAL CARBIDE BUR,2009011,CDM,272,RC,,,outpatient,,,199.5,99.75,,193.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,179.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,179.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,136.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,161.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,176.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,132.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,161.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,183.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,189.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,193.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,129.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,179.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,179.55,
CATH FOGERTY BILI 5FR,2009012,CDM,272,RC,,,outpatient,,,179.25,89.63,,173.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,161.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,161.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,122.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,144.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,158.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,118.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,145.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,164.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,170.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,173.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,116.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,161.33,
RROW BLADE STRYKER MED,2009013,CDM,272,RC,,,outpatient,,,233,116.5,,226.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,209.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,139.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,188.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,214.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,221.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,139.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,139.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,209.7,
CATH FOGERTY BILI 6FR,2009014,CDM,272,RC,,,outpatient,,,179.25,89.63,,173.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,161.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,161.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,122.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,144.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,158.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,118.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,145.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,164.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,170.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,173.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,116.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,161.33,
CATH SYSTEM LOCKING PIGGY BACK,2009015,CDM,272,RC,,,outpatient,,,234.5,117.25,,227.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,211.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,211.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,160.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,189.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,189.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,207.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,155.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,215.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,222.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,227.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,152.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,211.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,211.05,
NEEDLE SELDINGER ENTRY,2009017,CDM,272,RC,,,outpatient,,,35.5,17.75,,34.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.3,90,
CONNECTING TUBE,2009018,CDM,272,RC,,,outpatient,,,51.5,25.75,,49.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,46.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,35.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,41.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,47.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,48.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,49.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.9,90,
DRESSING SILVASORB,2009020,CDM,272,RC,,,outpatient,,,94,47,,91.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,84.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,64.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,62.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,76.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,86.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,89.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,91.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.4,90,
GEL SILVASORB,2009021,CDM,272,RC,,,outpatient,,,122,61,,118.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,109.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,98.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,115.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,118.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,109.8,
GUIDE WIRE 70MM VISIGLIDE,2009023,CDM,278,RC,,,outpatient,,,411,205.5,,398.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,246.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.78,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,369.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,369.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,246.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,280.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,246.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,331.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,331.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,364.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,272.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,332.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,378.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,390.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,398.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,267.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,246.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,246.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,246.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,369.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,246.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,246.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,369.9,
GUIDE WIRE CRE  FIXED WIRE BALLOON,2009024,CDM,278,RC,,,outpatient,,,685.5,342.75,,664.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,411.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.78,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,616.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,616.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,411.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,498.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,467.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,411.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,553.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,553.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,607.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,454.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,555.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,630.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,651.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,664.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,445.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,411.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,411.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,411.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,616.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,411.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,411.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,616.95,
TWISTER PLUS,2009025,CDM,278,RC,,,outpatient,,,257.75,128.88,,250.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,154.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.78,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,231.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,231.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,154.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.54,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,175.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,154.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,228.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,170.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,208.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,237.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,244.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,250.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,167.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,154.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,231.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,154.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,154.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,231.98,
WATER TUBE CHANNEL,2009026,CDM,272,RC,,,outpatient,,,79,39.5,,76.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,53.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,63.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,72.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,76.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.4,90,
BREAST NEEDLE 20G,2009027,CDM,272,RC,,,outpatient,,,129.5,64.75,,125.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,116.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,116.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,88.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,77.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,104.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,85.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,104.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,119.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,123.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,125.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,77.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,77.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,116.55,
DILATOR A,2009028,CDM,272,RC,,,outpatient,,,71.5,35.75,,69.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,57.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,65.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,67.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,90,
DILATOR B,2009029,CDM,272,RC,,,outpatient,,,147.25,73.63,,142.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,132.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,100.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,88.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,97.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,119.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,135.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,139.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,142.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,88.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,88.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,132.53,
PNEUMOTHOREX SET,2009030,CDM,272,RC,,,outpatient,,,397.25,198.63,,385.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,238.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,357.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,357.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,238.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,289.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,271.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,238.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,320.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,352,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,263.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,321.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,365.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,377.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,385.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,258.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,238.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,357.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,238.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,238.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,357.53,
MULTI DRAIN CATHETER A,2009031,CDM,272,RC,,,outpatient,,,344.5,172.25,,334.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,206.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,310.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,310.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,206.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,235.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,206.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,278.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,278.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,305.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,228.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,279.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,316.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,327.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,334.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,223.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,206.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,310.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,206.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,206.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,310.05,
MULTI DRAIN CATHETER,2009032,CDM,272,RC,,,outpatient,,,344.5,172.25,,334.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,206.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,310.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,310.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,206.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,235.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,206.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,278.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,278.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,305.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,228.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,279.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,316.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,327.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,334.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,223.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,206.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,310.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,206.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,206.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,310.05,
DRAIN CATHETER,2009033,CDM,272,RC,,,outpatient,,,344.5,172.25,,334.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,206.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,310.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,310.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,206.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,235.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,206.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,278.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,278.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,305.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,228.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,279.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,316.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,327.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,334.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,223.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,206.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,310.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,206.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,206.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,310.05,
HUMIDIFIER H5I CLEABLE,2009034,CDM,272,RC,,,outpatient,,,23.75,11.88,,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,90,
GUIDE WIRE URO,2009035,CDM,278,RC,,,outpatient,,,199.5,99.75,,193.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.78,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,179.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,179.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,136.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,161.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,176.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,132.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,161.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,183.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,189.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,193.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,129.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,179.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,119.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,179.55,
BIO FORCEP BACKLOAD,2009036,CDM,272,RC,,,outpatient,,,1020.75,510.38,,990.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,612.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,306.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,918.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,918.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,612.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,742.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,696.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,612.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,823.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,823.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,904.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,676.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,826.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,939.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,969.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,990.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,663.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,612.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,612.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,612.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,918.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,612.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,612.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,918.68,
NEEDLE BREAST LESION LOCATION,2009037,CDM,272,RC,,,outpatient,,,188.5,94.25,,182.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,169.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,169.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,128.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,167.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,124.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,152.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,173.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,179.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,182.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,122.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,169.65,
FORCEPS HOT MAX,2009038,CDM,272,RC,,,outpatient,,,1118.75,559.38,,1085.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,671.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,335.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,1006.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,1006.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,671.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,814,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,763.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,671.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,903.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,903.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,991.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,741.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,906.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1029.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,1062.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,1085.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,727.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,671.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,671.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,671.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1006.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,671.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,671.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1006.88,
YUEH CENT DISP CATH NEEDLE,2009039,CDM,272,RC,,,outpatient,,,152.5,76.25,,147.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,137.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,104.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,91.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,101.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,123.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,140.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,144.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,147.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,91.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,91.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,137.25,
FORCEPS DISP FOR CYSTO,2009041,CDM,272,RC,,,outpatient,,,126.25,63.13,,122.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,113.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,86.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,75.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,111.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,83.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,102.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,116.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,119.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,122.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,75.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,75.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,113.63,
FORCEPS DISP BIO 2300,2009042,CDM,272,RC,,,outpatient,,,32.75,16.38,,31.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,31.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,90,
FORCEPS DISP BIO1150,2009043,CDM,272,RC,,,outpatient,,,117.25,58.63,,113.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,105.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,80.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,107.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,111.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,105.53,
CATH URETHRAL 5FR,2009044,CDM,272,RC,,,outpatient,,,95.5,47.75,,92.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,85.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,65.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,63.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,77.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,87.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,90.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,92.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.3,90,
DILATOR,2009045,CDM,272,RC,,,outpatient,,,71.5,35.75,,69.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,57.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,65.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,67.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,90,
BREAST NEEDLE 21G,2009047,CDM,272,RC,,,outpatient,,,203,101.5,,196.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,182.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,138.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,163.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,179.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,134.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,164.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,186.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,192.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,196.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,182.7,
WIRE GUIDE FIXED CORE,2009049,CDM,272,RC,,,outpatient,,,122,61,,118.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,109.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,98.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,115.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,118.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,109.8,
GUIDE WIRE BENTSON,2009050,CDM,278,RC,,,outpatient,,,183,91.5,,177.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.78,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,164.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,124.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,148.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,168.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,173.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,177.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,109.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,164.7,
SCREW CORTEX 32MM,2009051,CDM,270,RC,,,outpatient,,,198,99,,192.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,178.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,178.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,135.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,118.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,159.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,175.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,131.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,160.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,182.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,188.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,192.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,128.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,118.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,118.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,178.2,
SCREW CORTEX 28MM,2009052,CDM,270,RC,,,outpatient,,,198,99,,192.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,178.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,178.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,135.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,118.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,159.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,175.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,131.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,160.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,182.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,188.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,192.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,128.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,118.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,118.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,178.2,
WIRE K 1.0,2009053,CDM,270,RC,,,outpatient,,,356.25,178.13,,345.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,320.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,243.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,315.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,236.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,288.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,327.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,338.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,345.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,231.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,320.63,
WIRE K 1.6,2009054,CDM,270,RC,,,outpatient,,,366.75,183.38,,355.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,220.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,330.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,330.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,220.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,266.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,250.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,220.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,296.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,296.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,324.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,243.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,297.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,337.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,348.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,355.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,238.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,220.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,220.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,220.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,330.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,220.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,220.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,330.08,
WIRE K 1.25,2009055,CDM,270,RC,,,outpatient,,,381,190.5,,369.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,228.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,342.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,342.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,228.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,277.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,260.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,228.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,307.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,307.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,337.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,252.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,308.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,350.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,361.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,369.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,247.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,228.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,228.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,228.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,342.9,
SCREW CORTEX 30MM,2009056,CDM,270,RC,,,outpatient,,,172.25,86.13,,167.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,117.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,139.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,158.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,163.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,167.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,155.03,
SCREW CORTEX 32MM,2009057,CDM,270,RC,,,outpatient,,,172.25,86.13,,167.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,117.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,139.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,158.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,163.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,167.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,155.03,
CONNECTOR DOUBLE SWIVEL,2009059,CDM,272,RC,,,outpatient,,,8.25,4.13,,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,90,
SCREW CORTEX 34MM,2009060,CDM,270,RC,,,outpatient,,,172.25,86.13,,167.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,117.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,139.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,158.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,163.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,167.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,155.03,
DRILL BIT BRASSELERS 2.0,2009061,CDM,270,RC,,,outpatient,,,348.75,174.38,,338.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,209.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,313.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,253.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,238.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,209.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,281.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,281.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,309.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,231.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,282.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,320.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,331.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,338.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,226.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,209.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,209.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,313.88,
DRILL BIT  2.7   # 315.28,2009062,CDM,270,RC,,,outpatient,,,493.75,246.88,,478.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,296.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,444.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,444.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,296.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,359.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,336.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,296.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,398.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,398.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,437.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,327.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,399.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,454.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,469.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,478.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,320.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,296.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,296.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,296.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,444.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,296.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,296.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,444.38,
SCREW CORTEX 36MM 202-836,2009063,CDM,270,RC,,,outpatient,,,172.25,86.13,,167.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,117.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,139.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,158.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,163.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,167.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,155.03,
SCREW CORTEX 38MM,2009064,CDM,270,RC,,,outpatient,,,172.25,86.13,,167.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,117.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,139.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,158.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,163.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,167.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,155.03,
BUR CUTTING SIDE 3.2MM,2009065,CDM,270,RC,,,outpatient,,,224.75,112.38,,218.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,153.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,181.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,199.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,182.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,206.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,213.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,218.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,202.28,
BUR CUTTING SIDE FISSURE,2009066,CDM,270,RC,,,outpatient,,,224.75,112.38,,218.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,153.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,181.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,199.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,182.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,206.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,213.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,218.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,202.28,
BUR OVAL,2009067,CDM,270,RC,,,outpatient,,,90,45,,87.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27,30,,,percent of total billed charges,Pays at 30% of total billed charges,81,90,,,percent of total billed charges,Pays at 90% of total billed charges,81,90,,,percent of total billed charges,Pays at 90% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,72.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,82.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,85.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,87.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,Pays at 90% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54,90,
BUR STANDARD ROUND,2009068,CDM,270,RC,,,outpatient,,,224.75,112.38,,218.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,153.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,181.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,199.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,182.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,206.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,213.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,218.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,202.28,
BUR STANDARD ROUND 3.2,2009069,CDM,270,RC,,,outpatient,,,224.75,112.38,,218.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,153.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,181.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,199.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,182.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,206.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,213.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,218.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,202.28,
DRILL BIT  2.7  100MM   # 310-26,2009070,CDM,270,RC,,,outpatient,,,300.5,150.25,,291.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,180.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,270.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,270.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,180.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,205.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,180.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,242.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,266.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,199.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,243.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,276.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,285.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,291.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,195.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,180.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,270.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,180.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,180.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,270.45,
DRILL BIT  2.0  140MM 323.062,2009071,CDM,270,RC,,,outpatient,,,318.75,159.38,,309.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,191.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,286.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,286.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,191.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,231.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,217.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,191.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,257.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,257.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,282.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,211.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,258.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,293.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,302.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,309.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,207.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,191.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,191.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,191.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,286.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,191.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,191.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,286.88,
WIRE K 1.6MM 292.56,2009072,CDM,278,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,90,
SCREW CORTEX 202-888,2009073,CDM,278,RC,,,outpatient,,,145.5,72.75,,141.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,130.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,99.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,117.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,96.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,133.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,138.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,141.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.95,
SCREW CORTEX 2.7 202.834,2009075,CDM,278,RC,,,outpatient,,,172.25,86.13,,167.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,117.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,139.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,158.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,163.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,167.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,155.03,
SCREW CORTEX2.7 202.836,2009076,CDM,278,RC,,,outpatient,,,172.25,86.13,,167.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,117.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,139.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,158.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,163.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,167.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,155.03,
TRAY LACERATION,2009077,CDM,272,RC,,,outpatient,,,15.5,7.75,,15.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,90,
PERCUTANEOUS TRACH KIT SIZE 7,2009078,CDM,272,RC,,,outpatient,,,947,473.5,,918.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,568.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,284.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,852.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,852.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,568.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,689.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,646.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,568.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,764.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,764.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,839.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,627.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,767.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,871.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,899.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,918.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,615.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,568.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,568.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,568.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,852.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,568.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,568.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,852.3,
PERCUTANEOUS TRACH KIT SIZE 8,2009079,CDM,272,RC,,,outpatient,,,894.5,447.25,,867.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,536.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,268.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,805.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,805.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,536.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,650.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,610.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,536.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,722.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,722.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,792.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,593.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,724.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,822.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,849.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,867.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,581.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,536.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,536.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,536.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,805.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,536.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,536.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,805.05,
SCREW CORTEX 204.030,2009081,CDM,278,RC,,,outpatient,,,201,100.5,,194.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,180.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,180.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,137.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,178.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,133.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,162.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,184.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,190.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,194.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,130.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,180.9,
SCREW CORTEX 204.034,2009082,CDM,278,RC,,,outpatient,,,201,100.5,,194.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,180.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,180.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,137.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,178.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,133.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,162.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,184.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,190.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,194.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,130.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,180.9,
SCREW CORTEX 204.036,2009083,CDM,278,RC,,,outpatient,,,201,100.5,,194.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,180.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,180.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,137.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,178.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,133.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,162.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,184.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,190.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,194.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,130.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,120.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,180.9,
WIRE K 1.25M150MM 292.12,2009085,CDM,270,RC,,,outpatient,,,74,37,,71.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,66.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,66.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,50.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,44.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,59.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,49.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,59.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,68.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,70.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,71.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,44.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,44.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.4,90,
DRILL BIT  2.0  125MM 310.21,2009086,CDM,270,RC,,,outpatient,,,338.5,169.25,,328.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,203.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,304.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,304.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,246.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,231.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,203.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,273.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,299.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,224.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,274.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,311.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,321.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,328.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,220.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,203.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,304.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,203.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,304.65,
DRILL BIT GOLD  2.5  110MM 310.25,2009087,CDM,270,RC,,,outpatient,,,155,77.5,,150.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,139.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,105.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,137.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,102.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,125.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,142.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,147.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,150.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,139.5,
SCREW CORTEX TAP 3.5MM 311.32,2009089,CDM,278,RC,,,outpatient,,,896.25,448.13,,869.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,537.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,806.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,806.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,537.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,652.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,611.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,537.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,723.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,723.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,794.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,594.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,725.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,824.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,851.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,869.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,582.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,537.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,537.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,537.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,806.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,537.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,537.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,806.63,
STOCKINETTE SMALL 7,2009091,CDM,271,RC,,,outpatient,,,22,11,,21.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,19.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,21.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.2,90,
STOCKINETTE MED 9,2009093,CDM,271,RC,,,outpatient,,,18.5,9.25,,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,90,
STOCKINETTE LARGE 12,2009094,CDM,271,RC,,,outpatient,,,28,14,,27.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,90,
ROSIDAL SOFT 10 CM,2009095,CDM,272,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
ROSIDAL SOFT 15CM,2009097,CDM,272,RC,,,outpatient,,,64,32,,62.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,51.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,58.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,60.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,62.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.4,90,
NEEDLE TROCAR,2009098,CDM,272,RC,,,outpatient,,,54.5,27.25,,52.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,49.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,44.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,50.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,51.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,52.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.7,90,
NEEDLE TROCAR,2009099,CDM,272,RC,,,outpatient,,,54.5,27.25,,52.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,49.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,44.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,50.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,51.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,52.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,32.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.7,90,
NUANCE W/ S/M/L CUSHION W/ FABRIC FRAME,2009100,CDM,271,RC,,,outpatient,,,71.75,35.88,,69.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,58.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,66.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,68.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.05,90,
NUANCEPRO W/HEADGEAR,2009101,CDM,271,RC,,,outpatient,,,214.5,107.25,,208.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,193.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,193.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,146.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,173.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,190.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,142.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,173.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,197.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,203.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,208.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,193.05,
BUR 4.0 OVAL SOLID,2009102,CDM,272,RC,,,outpatient,,,128.5,64.25,,124.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,87.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,85.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,104.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,118.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,122.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,124.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,115.65,
BUR 6.0 ROUND FLUTED,2009103,CDM,272,RC,,,outpatient,,,198.5,99.25,,192.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,178.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,178.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,135.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,175.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,131.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,160.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,182.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,188.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,192.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,129.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,178.65,
BUR 5.0 ROUND FLUTED,2009104,CDM,272,RC,,,outpatient,,,198.5,99.25,,192.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,178.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,178.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,135.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,175.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,131.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,160.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,182.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,188.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,192.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,129.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,119.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,178.65,
DRILL BIT 2.0 STERILE,2009105,CDM,272,RC,,,outpatient,,,257.5,128.75,,249.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,154.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,231.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,231.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,154.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.36,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,175.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,154.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,207.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,228.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,170.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,208.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,236.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,244.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,249.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,167.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,154.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,231.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,154.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,154.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,231.75,
WIRE Kirschner style 6.9mmx229mm,2009107,CDM,270,RC,,,outpatient,,,28.5,14.25,,27.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,90,
"WIRE Kirschner style 6, 1.1mmx229mm",2009108,CDM,270,RC,,,outpatient,,,28.5,14.25,,27.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,90,
"WIRE Kirschner style 6, 1.6mmx229mm",2009109,CDM,270,RC,,,outpatient,,,28.5,14.25,,27.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,90,
"PINS STEINMANN STYLE 6, 2.0mmx229mm",2009110,CDM,270,RC,,,outpatient,,,33.25,16.63,,32.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,29.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.95,90,
"PINS STEINMANN STYLE 6, 2.4mmx229mm",2009111,CDM,270,RC,,,outpatient,,,33.25,16.63,,32.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,29.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.95,90,
"PINS STEINMANN STYLE 6, 2.8mmx229mm",2009112,CDM,270,RC,,,outpatient,,,33.25,16.63,,32.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,29.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.95,90,
"PINS STEINMANN STYLE 6, 3.2mmx229mm",2009113,CDM,270,RC,,,outpatient,,,48.25,24.13,,46.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,43.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,39.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,44.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,45.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,46.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.95,90,
"PINS STEINMANN STYLE 6, 3.6mmx229mm",2009115,CDM,270,RC,,,outpatient,,,51.75,25.88,,50.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,46.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,35.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,41.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,47.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,49.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,50.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.05,90,
"PINS STEINMANN STYLE 6, 4.0mmx229mm",2009116,CDM,270,RC,,,outpatient,,,41.75,20.88,,40.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,38.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,39.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.05,90,
"PINS STEINMANN STYLE 6, 4.8mmx229mm",2009117,CDM,270,RC,,,outpatient,,,41.75,20.88,,40.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,38.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,39.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.05,90,
NEEDLE HUBER MINI LOC 1'',2009118,CDM,272,RC,,,outpatient,,,55.25,27.63,,53.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,49.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,44.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,50.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,52.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,53.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.15,90,
NEEDLE HUBER MINI LOC 1.5'',2009119,CDM,272,RC,,,outpatient,,,55.25,27.63,,53.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,49.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,44.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,50.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,52.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,53.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.15,90,
NEEDLE spil 22ga,2009120,CDM,272,RC,,,outpatient,,,13,6.5,,12.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,90,
SUTURE4.0 SURGIPRO p12 SP5682,2009123,CDM,272,RC,,,outpatient,,,41.5,20.75,,40.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,37.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,38.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,39.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,24.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.9,90,
SUTURE4.0 SURGIPRO p12 SP5686,2009124,CDM,272,RC,,,outpatient,,,14.5,7.25,,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,90,
DRILL BIT 2.4 STERILE,2009133,CDM,272,RC,,,outpatient,,,257.5,128.75,,249.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,154.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,231.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,231.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,154.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.36,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,175.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,154.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,207.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,228.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,170.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,208.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,236.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,244.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,249.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,167.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,154.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,231.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,154.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,154.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,231.75,
BOVIE /NEEDLE TIP,2009136,CDM,272,RC,,,outpatient,,,17.25,8.63,,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,90,
BOVIE - SUCTION DISP,2009144,CDM,272,RC,,,outpatient,,,47,23.5,,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,38.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,43.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,90,
SCREW ACUTRAK micro 18mm,2009147,CDM,278,RC,,,outpatient,,,1525.5,762.75,,1479.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,915.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1372.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,1372.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,915.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1109.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1041.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,915.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1231.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1231.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1351.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1011.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1235.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1403.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,1449.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,1479.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,991.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,915.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,915.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,915.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1372.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,915.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,915.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1372.95,
DRIVER TIP quick cann 1.5mm,2009148,CDM,272,RC,,,outpatient,,,949,474.5,,920.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,569.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,284.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,854.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,854.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,569.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,690.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,647.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,569.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,766.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,766.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,840.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,629.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,768.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,873.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,901.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,920.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,616.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,569.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,569.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,569.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,854.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,569.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,569.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,854.1,
DRILL ACUTRAK MICRO,2009149,CDM,272,RC,,,outpatient,,,720,360,,698.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,432,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,216,30,,,percent of total billed charges,Pays at 30% of total billed charges,648,90,,,percent of total billed charges,Pays at 90% of total billed charges,648,90,,,percent of total billed charges,Pays at 90% of total billed charges,432,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,523.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,491.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,432,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,581.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,581.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,637.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,477.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,583.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,662.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,684,95,,,percent of total billed charges,Pays at 95% of total billed charges,698.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,468,65,,,percent of total billed charges,Pays at 65% of total billed charges,432,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,432,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,432,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,648,90,,,percent of total billed charges,Pays at 90% of total billed charges,432,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,432,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,648,
GUIDE WIRE  0.035,2009150,CDM,272,RC,,,outpatient,,,105.25,52.63,,102.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,71.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,69.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,85.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,96.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,99.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,102.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,94.73,
K WIRE double trocar  0.356,2009151,CDM,278,RC,,,outpatient,,,14.75,7.38,,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,90,
K WIRE double trocar  0.546,2009152,CDM,278,RC,,,outpatient,,,14.75,7.38,,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,90,
K WIRE double trocar  0.359,2009153,CDM,278,RC,,,outpatient,,,15.75,7.88,,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,90,
K WIRE double trocar 0.549,2009154,CDM,278,RC,,,outpatient,,,15.75,7.88,,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,90,
NYLON DOUBLE ENDED BRUSH,2009155,CDM,272,RC,,,outpatient,,,41,20.5,,39.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,36.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.6,90,
HYDROSET XT 5CC,2009181,CDM,270,RC,,,outpatient,,,5426,2713,,5263.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,3255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1627.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,4883.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,4883.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3947.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3703.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4379.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4379.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4807.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3597.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4395.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4991.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,5154.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,5263.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,3526.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,3255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4883.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4883.4,
SUTURE ANCHOR BIOCOMP,2009183,CDM,270,RC,,,outpatient,,,740.5,370.25,,718.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,444.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,666.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,666.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,444.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,538.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,505.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,444.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,597.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,597.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,656.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,490.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,599.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,681.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,703.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,718.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,481.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,444.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,444.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,444.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,666.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,444.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,444.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,666.45,
K WIRE 1.25X1.50MM SS,2009185,CDM,270,RC,,,outpatient,,,64.5,32.25,,62.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,58.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,52.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,59.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,62.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.7,90,
K WIRE 1.6X1.50MM SS,2009186,CDM,270,RC,,,outpatient,,,62.75,31.38,,60.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,56.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,42.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,50.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,57.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,59.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,60.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,37.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.65,90,
K WIRE TROCAR POINT,2009187,CDM,270,RC,,,outpatient,,,172.25,86.13,,167.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,117.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,139.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,158.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,163.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,167.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,155.03,
COUNTERSINK FOR SCREWS 0.27/3.5 AO FITTI,2009188,CDM,270,RC,,,outpatient,,,120.25,60.13,,116.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.23,
WASHER T8 &T10 SCREW 2.4MM,2009189,CDM,270,RC,,,outpatient,,,33,16.5,,32.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,29.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.8,90,
LOCKING SCREW T8 FULL TREAD 2.4MM,2009190,CDM,278,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
LOCKING SCREW T8 FULL TREAD 2.4MM L10,2009191,CDM,278,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
LOCKING SCREW T8 FULL TREAD 2.4MM L12,2009192,CDM,278,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
LOCKING SCREW T8 FULL TREAD 2.4MM L14,2009193,CDM,278,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
LOCKING SCREW T8 FULL TREAD 2.4MM L16,2009194,CDM,278,RC,,,outpatient,,,534.25,267.13,,518.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,320.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,480.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,480.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,388.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,364.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,320.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,431.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,431.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,473.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,354.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,432.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,491.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,507.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,518.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,347.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,320.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,480.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,320.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,480.83,
LOCKING SCREW T8 FULL TREAD 2.4MM L18,2009195,CDM,278,RC,,,outpatient,,,534.25,267.13,,518.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,320.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,480.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,480.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,388.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,364.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,320.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,431.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,431.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,473.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,354.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,432.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,491.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,507.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,518.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,347.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,320.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,480.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,320.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,480.83,
LOCKING SCREW T8 FULL TREAD 2.4MM L20,2009196,CDM,278,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
LOCKING SCREW T8 FULL TREAD 2.4MM L22,2009197,CDM,278,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
LOCKING SCREW T8 FULL TREAD 2.4MM L24,2009198,CDM,278,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
LOCKING SCREW T8 FULL TREAD 2.4MM L26,2009199,CDM,278,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
LOCKING SCREW T8 FULL TREAD 2.4MM L28,2009201,CDM,278,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
LOCKING SCREW T8 FULL TREAD 2.4MM L30,2009202,CDM,278,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
LOCKING SCREW T8 FULL TREAD 2.4MM L32,2009203,CDM,278,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
LOCKING SCREW T8 FULL TREAD 2.4MM L34,2009204,CDM,278,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
LOCKING SCREW T8 FULL TREAD 2.4MM L36,2009205,CDM,270,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
LOCKING SCREW T8 FULL TREAD 2.4MM L38,2009206,CDM,270,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
BONE SCREW T8 F/T2.4 L8MM,2009207,CDM,270,RC,,,outpatient,,,314.25,157.13,,304.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,282.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,282.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,214.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,253.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,253.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,278.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,208.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,254.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,289.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,298.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,304.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,204.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,282.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,282.83,
BONE SCREW T8 F/T2.4 L10MM,2009208,CDM,270,RC,,,outpatient,,,314.25,157.13,,304.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,282.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,282.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,214.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,253.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,253.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,278.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,208.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,254.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,289.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,298.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,304.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,204.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,282.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,282.83,
BONE SCREW T8 F/T2.4 L12MM,2009209,CDM,270,RC,,,outpatient,,,82.5,41.25,,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,
BONE SCREW T8 F/T2.4 L14MM,2009210,CDM,270,RC,,,outpatient,,,82.5,41.25,,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,
BONE SCREW T8 F/T2.4 L16MM,2009211,CDM,270,RC,,,outpatient,,,82.5,41.25,,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,
K WIRE TROCAR POINT,2009219,CDM,270,RC,,,outpatient,,,17.25,8.63,,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,90,
PLATE TIBIA,2009220,CDM,270,RC,,,outpatient,,,6031.5,3015.75,,5850.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,3618.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1809.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,5428.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,5428.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,3618.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4388.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4116.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3618.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4868.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4868.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5344.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3998.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4885.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5548.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,5729.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,5850.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,3920.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,3618.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3618.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3618.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5428.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,3618.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3618.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,5428.35,
SCREW LOCKING 4MM,2009221,CDM,270,RC,,,outpatient,,,541.75,270.88,,525.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,487.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,487.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,394.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,369.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,437.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,437.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,480.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,359.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,438.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,498.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,514.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,525.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,352.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,487.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,487.58,
SCREW LOCKING 4MM,2009222,CDM,270,RC,,,outpatient,,,541.75,270.88,,525.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,487.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,487.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,394.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,369.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,437.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,437.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,480.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,359.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,438.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,498.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,514.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,525.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,352.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,487.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,487.58,
SCREW LOCKING 4MM,2009223,CDM,270,RC,,,outpatient,,,541.75,270.88,,525.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,487.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,487.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,394.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,369.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,437.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,437.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,480.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,359.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,438.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,498.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,514.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,525.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,352.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,487.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,487.58,
SCREW CORTEX 3.5MM,2009224,CDM,270,RC,,,outpatient,,,226,113,,219.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,203.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,154.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,183.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,207.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,214.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,219.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,203.4,
SCREW CORTEX 3.5MM,2009225,CDM,270,RC,,,outpatient,,,223,111.5,,216.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,133.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,200.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,152.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,133.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,180.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,197.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,147.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,180.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,205.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,211.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,216.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,144.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,133.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,133.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,200.7,
SCREW CORTEX 3.5MM,2009227,CDM,270,RC,,,outpatient,,,226,113,,219.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,203.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,154.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,183.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,207.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,214.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,219.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,203.4,
SCREW CORTEX 3.5MM,2009228,CDM,270,RC,,,outpatient,,,226,113,,219.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,203.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,154.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,183.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,207.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,214.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,219.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,203.4,
DRILL TWIST,2009229,CDM,270,RC,,,outpatient,,,684.75,342.38,,664.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,410.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,616.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,616.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,410.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,498.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,467.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,410.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,552.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,552.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,606.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,453.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,554.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,629.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,650.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,664.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,445.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,410.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,410.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,410.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,616.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,410.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,410.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,616.28,
DRILL BIT,2009230,CDM,270,RC,,,outpatient,,,893.75,446.88,,866.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,536.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,268.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,804.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,804.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,536.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,650.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,609.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,536.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,721.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,721.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,791.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,592.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,723.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,822.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,849.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,866.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,580.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,536.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,536.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,536.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,804.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,536.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,536.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,804.38,
LOCKING SCREW T10 FULL TREAD 2.7MM L55mm,2009231,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
DRILL BIT,2009232,CDM,270,RC,,,outpatient,,,881.25,440.63,,854.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,528.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,264.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,793.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,793.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,528.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,641.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,601.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,528.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,711.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,711.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,780.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,584.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,713.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,810.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,837.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,854.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,572.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,528.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,528.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,528.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,793.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,528.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,528.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,793.13,
SCREW CANCELLOUS TI 4MM,2009233,CDM,278,RC,,,outpatient,,,118,59,,114.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,106.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,80.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,70.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,95.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,104.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,78.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,95.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,108.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,112.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,114.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,70.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,70.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,106.2,
PLATE PROX LATERL TIBIA,2009235,CDM,278,RC,,,outpatient,,,5339,2669.5,,5178.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,3203.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1601.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,4805.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,4805.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,3203.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3884.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3643.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3203.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4309.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4309.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4730.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3539.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4324.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4911.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,5072.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,5178.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,3470.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,3203.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3203.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3203.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4805.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,3203.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3203.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4805.1,
SCREW LOCKING 400,2009237,CDM,270,RC,,,outpatient,,,526,263,,510.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,315.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,473.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,473.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,315.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,382.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,359,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,315.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,424.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,424.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,466.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,348.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,426.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,483.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,499.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,510.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,341.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,315.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,315.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,315.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,473.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,315.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,315.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,473.4,
SCREW LOCKING 4MM,2009239,CDM,270,RC,,,outpatient,,,526,263,,510.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,315.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,473.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,473.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,315.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,382.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,359,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,315.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,424.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,424.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,466.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,348.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,426.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,483.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,499.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,510.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,341.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,315.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,315.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,315.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,473.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,315.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,315.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,473.4,
SCREW LOCKING 4MM,2009240,CDM,270,RC,,,outpatient,,,526,263,,510.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,315.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,473.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,473.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,315.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,382.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,359,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,315.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,424.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,424.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,466.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,348.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,426.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,483.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,499.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,510.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,341.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,315.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,315.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,315.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,473.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,315.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,315.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,473.4,
SCREW CORTEX 3.5MM,2009241,CDM,270,RC,,,outpatient,,,219.5,109.75,,212.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,197.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,197.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,149.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,177.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,194.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,145.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,177.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,201.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,208.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,212.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,142.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,197.55,
SCREW CORTEX 3.5MM,2009243,CDM,270,RC,,,outpatient,,,219.5,109.75,,212.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,197.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,197.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,149.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,177.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,194.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,145.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,177.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,201.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,208.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,212.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,142.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,197.55,
SCREW CORTEX 3.5MM,2009245,CDM,270,RC,,,outpatient,,,219.5,109.75,,212.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,197.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,197.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,149.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,177.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,194.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,145.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,177.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,201.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,208.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,212.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,142.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,197.55,
FACE MASK #5220 INFA,2009246,CDM,271,RC,,,outpatient,,,19.75,9.88,,19.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,17.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,18.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.85,90,
TRIDENT 10X3 INSERT 32MM,2009247,CDM,270,RC,,,outpatient,,,2534.5,1267.25,,2458.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,1520.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,760.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,2281.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,2281.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1520.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1844.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1729.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1520.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2045.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2045.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2245.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1680.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2052.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2331.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,2407.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,2458.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,1647.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,1520.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1520.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1520.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2281.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1520.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1520.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2281.05,
FACE MASK #5230 TODD,2009248,CDM,271,RC,,,outpatient,,,19.75,9.88,,19.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,17.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,18.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.85,90,
V40 BIOLOX DELTAHEAD,2009249,CDM,270,RC,,,outpatient,,,2704.75,1352.38,,2623.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,1622.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,811.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,2434.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,2434.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1622.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1967.98,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1845.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1622.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2183.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2183.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2396.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1793.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2190.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2488.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,2569.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,2623.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,1758.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,1622.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1622.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1622.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2434.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1622.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1622.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2434.28,
TRIDENT II TRITANIUM,2009251,CDM,270,RC,,,outpatient,,,3834.75,1917.38,,3719.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,2300.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1150.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,3451.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,3451.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,2300.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2790.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2617.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2300.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3095.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3095.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3397.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2542.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3106.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3527.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,3643.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,3719.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,2492.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,2300.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2300.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2300.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3451.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,2300.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2300.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3451.28,
TRANSDUCE DONE,2009252,CDM,271,RC,,,outpatient,,,69,34.5,,66.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,62.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,45.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,55.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,63.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,65.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,66.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.4,90,
SCREW HEX LW PROFILE 6.5MM,2009253,CDM,270,RC,,,outpatient,,,195,97.5,,189.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,175.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,175.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,133.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,157.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,172.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,129.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,157.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,179.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,185.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,189.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,126.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,175.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,175.5,
SCREW HEX LW PROFILE 6.5MM,2009255,CDM,270,RC,,,outpatient,,,195,97.5,,189.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,175.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,175.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,133.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,157.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,172.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,129.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,157.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,179.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,185.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,189.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,126.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,175.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,117,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,175.5,
TRIAHLON PSX3 TIBIAL INSERT,2009256,CDM,270,RC,,,outpatient,,,3808.5,1904.25,,3694.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,2285.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1142.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,3427.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,3427.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2285.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2771.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2599.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2285.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3074.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3074.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3374.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2525.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3084.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3503.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,3618.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,3694.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,2475.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,2285.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2285.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2285.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3427.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2285.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2285.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3427.65,
TRIAHLON SYMMERTRIC X3,2009257,CDM,270,RC,,,outpatient,,,1888.75,944.38,,1832.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,1133.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,566.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,1699.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,1699.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,1133.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1374.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1289.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1133.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1524.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1524.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1673.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1252.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1529.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1737.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,1794.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,1832.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,1227.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,1133.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1133.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1133.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1699.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,1133.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1133.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1699.88,
BONE SCREW T8 F/T2.4 L18MM,2009259,CDM,270,RC,,,outpatient,,,82.5,41.25,,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,
BONE SCREW T8 F/T2.4 L20MM,2009260,CDM,270,RC,,,outpatient,,,82.5,41.25,,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,
BONE SCREW T8 F/T2.4 L22MM,2009261,CDM,270,RC,,,outpatient,,,82.5,41.25,,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,
BONE SCREW T8 F/T2.4 L24MM,2009262,CDM,270,RC,,,outpatient,,,82.5,41.25,,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,
BONE SCREW T8 F/T2.4 L26MM,2009263,CDM,270,RC,,,outpatient,,,82.5,41.25,,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,
BONE SCREW T8 F/T2.4 L28MM,2009264,CDM,270,RC,,,outpatient,,,82.5,41.25,,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,
BONE SCREW T8 F/T2.4 L30MM,2009265,CDM,270,RC,,,outpatient,,,82.5,41.25,,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,
BONE SCREW T8 F/T2.4 L32MM,2009266,CDM,270,RC,,,outpatient,,,82.5,41.25,,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,
BONE SCREW T8 F/T2.4 L34MM,2009267,CDM,270,RC,,,outpatient,,,82.5,41.25,,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,
BONE SCREW T8 F/T2.4 L36MM,2009268,CDM,270,RC,,,outpatient,,,82.5,41.25,,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,
BONE SCREW T8 F/T2.4 L38MM,2009269,CDM,270,RC,,,outpatient,,,82.5,41.25,,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,
LOCKING SCREW T8 FULL TREAD 2.7MM L8mm,2009270,CDM,270,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
LOCKING SCREW T8 FULL TREAD 2.7MM L10mm,2009271,CDM,270,RC,,,outpatient,,,333,166.5,,323.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,199.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,299.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,299.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,199.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,227.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,199.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,268.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,268.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,295.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,220.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,269.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,306.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,316.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,323.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,216.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,199.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,199.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,199.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,299.7,
LOCKING SCREW T8 FULL TREAD 2.7MM L12mm,2009272,CDM,270,RC,,,outpatient,,,554.25,277.13,,537.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,332.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,498.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,498.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,332.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,403.27,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,378.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,332.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,447.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,447.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,491.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,367.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,448.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,509.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,526.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,537.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,360.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,332.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,332.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,332.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,498.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,332.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,332.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,498.83,
LOCKING SCREW T8 FULL TREAD 2.7MM L14mm,2009273,CDM,270,RC,,,outpatient,,,550.25,275.13,,533.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,495.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,495.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.36,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,375.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,444.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,444.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,487.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,364.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,445.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,506.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,522.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,533.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,357.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,495.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,495.23,
LOCKING SCREW T8 FULL TREAD 2.7MM L16mm,2009274,CDM,270,RC,,,outpatient,,,333,166.5,,323.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,199.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,299.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,299.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,199.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,227.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,199.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,268.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,268.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,295.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,220.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,269.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,306.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,316.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,323.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,216.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,199.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,199.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,199.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,299.7,
LOCKING SCREW T8 FULL TREAD 2.7MM L18mm,2009275,CDM,270,RC,,,outpatient,,,371.25,185.63,,360.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,334.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,334.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,270.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,253.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,299.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,328.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,246.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,300.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,341.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,352.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,360.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,241.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,334.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,334.13,
LOCKING SCREW T8 FULL TREAD 2.7MM L20mm,2009276,CDM,270,RC,,,outpatient,,,335,167.5,,324.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,201,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,301.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,301.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,201,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,228.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,201,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,270.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,270.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,296.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,222.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,271.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,308.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,318.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,324.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,217.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,201,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,301.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,201,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,201,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,301.5,
LOCKING SCREW T8 FULL TREAD 2.7MM L22mm,2009277,CDM,270,RC,,,outpatient,,,550.25,275.13,,533.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,495.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,495.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.36,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,375.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,444.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,444.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,487.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,364.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,445.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,506.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,522.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,533.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,357.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,495.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,330.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,495.23,
LOCKING SCREW T8 FULL TREAD 2.7MM L24mm,2009278,CDM,270,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
LOCKING SCREW T8 FULL TREAD 2.7MM L26mm,2009279,CDM,270,RC,,,outpatient,,,554.25,277.13,,537.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,332.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,498.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,498.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,332.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,403.27,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,378.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,332.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,447.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,447.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,491.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,367.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,448.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,509.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,526.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,537.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,360.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,332.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,332.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,332.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,498.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,332.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,332.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,498.83,
LOCKING SCREW T8 FULL TREAD 2.7MM L28mm,2009280,CDM,270,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
LOCKING SCREW T8 FULL TREAD 2.7MM L30mm,2009281,CDM,270,RC,,,outpatient,,,534.25,267.13,,518.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,320.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,480.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,480.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,388.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,364.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,320.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,431.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,431.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,473.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,354.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,432.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,491.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,507.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,518.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,347.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,320.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,480.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,320.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,480.83,
LOCKING SCREW T8 FULL TREAD 2.7MM L32mm,2009282,CDM,270,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
LOCKING SCREW T8 FULL TREAD 2.7MM L34mm,2009283,CDM,270,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
LOCKING SCREW T8 FULL TREAD 2.7MM L36mm,2009284,CDM,270,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
LOCKING SCREW T8 FULL TREAD 2.7MM L38mm,2009285,CDM,270,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
LOCKING SCREW T8 FULL TREAD 2.7MM L40mm,2009286,CDM,270,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
LOCKING SCREW T8 FULL TREAD 2.7MM L45mm,2009287,CDM,270,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
LOCKING SCREW T8 FULL TREAD 2.7MM L50mm,2009288,CDM,270,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
BONE SCREW T8 F/T2.7 L8MM,2009289,CDM,270,RC,,,outpatient,,,82.5,41.25,,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,
BONE SCREW T8 F/T2.7 L10MM,2009290,CDM,270,RC,,,outpatient,,,82.5,41.25,,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,
BONE SCREW T8 F/T2.7 L12MM,2009291,CDM,270,RC,,,outpatient,,,194.25,97.13,,188.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,174.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,132.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,172.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,128.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,157.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,178.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,184.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,188.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,126.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,174.83,
BONE SCREW T8 F/T2.7 L14MM,2009292,CDM,270,RC,,,outpatient,,,194.25,97.13,,188.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,174.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,132.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,172.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,128.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,157.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,178.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,184.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,188.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,126.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,174.83,
BONE SCREW T8 F/T2.7 L16MM,2009293,CDM,278,RC,,,outpatient,,,194.25,97.13,,188.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,174.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,132.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,172.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,128.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,157.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,178.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,184.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,188.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,126.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,174.83,
BONE SCREW T8 F/T2.7 L18MM,2009294,CDM,270,RC,,,outpatient,,,321.25,160.63,,311.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,289.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,289.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,233.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,219.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,259.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,284.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,212.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,260.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,295.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,305.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,311.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,208.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,289.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,289.13,
BONE SCREW T8 F/T2.7 L20MM,2009295,CDM,278,RC,,,outpatient,,,194.25,97.13,,188.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,174.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,132.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,172.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,128.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,157.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,178.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,184.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,188.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,126.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,174.83,
BONE SCREW T8 F/T2.7 L22MM,2009296,CDM,278,RC,,,outpatient,,,323.5,161.75,,313.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,194.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,291.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,291.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,194.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,220.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,194.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,261.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,261.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,286.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,214.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,262.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,297.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,307.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,313.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,210.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,194.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,291.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,194.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,194.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,291.15,
BONE SCREW T8 F/T2.7 L24MM,2009297,CDM,270,RC,,,outpatient,,,194.25,97.13,,188.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,174.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,132.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,172.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,128.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,157.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,178.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,184.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,188.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,126.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,174.83,
BONE SCREW T8 F/T2.7 L26MM,2009298,CDM,270,RC,,,outpatient,,,321.25,160.63,,311.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,289.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,289.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,233.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,219.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,259.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,284.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,212.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,260.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,295.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,305.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,311.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,208.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,289.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,289.13,
BONE SCREW T8 F/T2.7 L28MM,2009299,CDM,270,RC,,,outpatient,,,82.5,41.25,,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,
BONE SCREW T8 F/T2.7 L30MM,2009300,CDM,270,RC,,,outpatient,,,312,156,,302.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,187.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,280.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,280.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,212.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,187.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,251.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,276.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,206.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,252.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,287.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,296.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,302.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,202.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,187.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,280.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,187.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,280.8,
BONE SCREW T8 F/T2.7 L32MM,2009301,CDM,270,RC,,,outpatient,,,314.25,157.13,,304.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,282.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,282.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,214.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,253.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,253.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,278.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,208.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,254.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,289.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,298.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,304.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,204.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,282.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,282.83,
BONE SCREW T8 F/T2.7 L34MM,2009302,CDM,270,RC,,,outpatient,,,314.25,157.13,,304.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,282.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,282.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,214.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,253.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,253.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,278.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,208.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,254.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,289.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,298.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,304.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,204.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,282.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,188.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,282.83,
BONE SCREW T8 F/T2.7 L36MM,2009303,CDM,270,RC,,,outpatient,,,82.5,41.25,,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,
BONE SCREW T8 F/T2.7 L38MM,2009304,CDM,270,RC,,,outpatient,,,82.5,41.25,,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,
BONE SCREW T8 F/T2.7 L40MM,2009305,CDM,270,RC,,,outpatient,,,82.5,41.25,,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,
BONE SCREW T8 F/T2.7 L45MM,2009306,CDM,270,RC,,,outpatient,,,82.5,41.25,,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,
BONE SCREW T8 F/T2.7 L50MM,2009307,CDM,270,RC,,,outpatient,,,82.5,41.25,,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,
LOCKING SCREW T10 FULL TREAD 2.7MM L8mm,2009309,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 2.7MM L10mm,2009310,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 2.7MM L12mm,2009311,CDM,270,RC,,,outpatient,,,371.25,185.63,,360.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,334.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,334.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,270.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,253.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,299.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,328.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,246.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,300.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,341.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,352.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,360.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,241.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,334.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,334.13,
LOCKING SCREW T10 FULL TREAD 2.7MM L14mm,2009312,CDM,270,RC,,,outpatient,,,371.25,185.63,,360.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,334.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,334.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,270.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,253.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,299.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,328.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,246.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,300.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,341.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,352.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,360.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,241.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,334.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,334.13,
LOCKING SCREW T10 FULL TREAD 2.7MM L16mm,2009313,CDM,278,RC,,,outpatient,,,612.5,306.25,,594.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,551.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,551.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,445.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,418.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,494.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,494.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,542.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,406.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,496.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,563.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,581.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,594.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,398.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,551.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,551.25,
LOCKING SCREW T10 FULL TREAD 2.7MM L18mm,2009314,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 2.7MM L20mm,2009315,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 2.7MM L22mm,2009316,CDM,278,RC,,,outpatient,,,612.5,306.25,,594.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,551.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,551.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,445.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,418.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,494.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,494.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,542.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,406.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,496.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,563.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,581.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,594.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,398.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,551.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,551.25,
LOCKING SCREW T10 FULL TREAD 2.7MM L24mm,2009317,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 2.7MM L26mm,2009318,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 2.7MM L28mm,2009319,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 2.7MM L30mm,2009320,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 2.7MM L32mm,2009321,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 2.7MM L34mm,2009322,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 2.7MM L36mm,2009323,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 2.7MM L38mm,2009324,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 2.7MM L40mm,2009325,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 2.7MM L42mm,2009326,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 2.7MM L44mm,2009327,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 2.7MM L46mm,2009328,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 2.7MM L48mm,2009329,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 2.7MM L50mm,2009330,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 2.7MM L55mm,2009331,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 2.7MM L60mm,2009332,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 2.7MM L65mm,2009333,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
BONE SCREW T8 F/T2.7 L8MM,2009334,CDM,270,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,90,
LOCKING SCREW T10 FULL TREAD 2.7MM L70mm,2009335,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
BONE SCREW T10 F/T2.7 L10MM,2009336,CDM,270,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,90,
BONE SCREW T10 F/T2.7 L12MM,2009337,CDM,270,RC,,,outpatient,,,335.5,167.75,,325.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,301.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,301.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,244.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,228.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,270.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,270.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,297.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,222.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,271.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,308.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,318.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,325.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,218.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,301.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,301.95,
BONE SCREW T10 F/T2.7 L14MM,2009338,CDM,278,RC,,,outpatient,,,333.75,166.88,,323.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,200.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,300.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,300.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,227.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,200.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,269.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,295.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,221.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,270.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,307.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,317.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,323.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,216.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,200.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,300.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,200.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,300.38,
BONE SCREW T10 F/T2.7 L16MM,2009339,CDM,270,RC,,,outpatient,,,336.25,168.13,,326.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,302.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,302.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,244.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,229.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,271.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,297.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,222.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,272.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,309.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,319.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,326.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,218.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,302.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,302.63,
BONE SCREW T10 F/T2.7 L18MM,2009340,CDM,270,RC,,,outpatient,,,335.5,167.75,,325.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,301.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,301.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,244.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,228.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,270.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,270.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,297.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,222.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,271.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,308.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,318.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,325.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,218.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,301.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,301.95,
BONE SCREW T10 F/T2.7 L20MM,2009341,CDM,270,RC,,,outpatient,,,336.25,168.13,,326.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,302.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,302.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,244.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,229.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,271.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,297.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,222.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,272.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,309.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,319.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,326.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,218.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,302.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,302.63,
BONE SCREW T10 F/T2.7 L22MM,2009342,CDM,270,RC,,,outpatient,,,335.5,167.75,,325.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,301.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,301.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,244.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,228.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,270.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,270.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,297.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,222.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,271.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,308.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,318.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,325.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,218.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,301.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,301.95,
BONE SCREW T10 F/T2.7 L24MM,2009343,CDM,270,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,90,
BONE SCREW T10 F/T2.7 L26MM,2009344,CDM,270,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,90,
BONE SCREW T10 F/T2.7 L28MM,2009345,CDM,270,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,90,
BONE SCREW T10 F/T2.7 L30MM,2009346,CDM,270,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,90,
BONE SCREW T10 F/T2.7 L32MM,2009347,CDM,270,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,90,
BONE SCREW T10 F/T2.7 L34MM,2009348,CDM,270,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,90,
BONE SCREW T10 F/T2.7 L36MM,2009349,CDM,270,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,90,
BONE SCREW T10 F/T2.7 L38MM,2009350,CDM,270,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,90,
BONE SCREW T10 F/T2.7 L40MM,2009351,CDM,270,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,90,
BONE SCREW T10 F/T2.7 L42MM,2009352,CDM,270,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,90,
BONE SCREW T10 F/T2.7 L44MM,2009353,CDM,270,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,90,
BONE SCREW T10 F/T2.7 L46MM,2009354,CDM,270,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,90,
BONE SCREW T10 F/T2.7 L48MM,2009355,CDM,270,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,90,
BONE SCREW T10 F/T2.7 L50MM,2009356,CDM,270,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,90,
BONE SCREW T10 F/T2.7 L55MM,2009357,CDM,270,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,90,
BONE SCREW T10 F/T2.7 L60MM,2009358,CDM,270,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,90,
BONE SCREW T10 F/T2.7 L65MM,2009359,CDM,270,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,90,
BONE SCREW T10 F/T2.7 L70MM,2009360,CDM,270,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,90,
LOCKING SCREW T10 FULL TREAD 3.5MM L8mm,2009361,CDM,270,RC,,,outpatient,,,612.5,306.25,,594.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,551.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,551.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,445.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,418.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,494.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,494.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,542.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,406.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,496.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,563.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,581.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,594.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,398.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,551.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,551.25,
LOCKING SCREW T10 FULL TREAD 3.5MM L10mm,2009362,CDM,270,RC,,,outpatient,,,617,308.5,,598.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,370.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,555.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,555.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,370.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,448.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,421.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,370.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,498.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,498.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,546.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,409.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,499.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,567.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,586.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,598.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,401.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,370.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,555.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,370.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,370.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,555.3,
LOCKING SCREW T10 FULL TREAD 3.5MM L12mm,2009363,CDM,278,RC,,,outpatient,,,371.25,185.63,,360.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,334.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,334.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,270.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,253.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,299.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,328.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,246.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,300.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,341.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,352.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,360.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,241.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,334.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,222.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,334.13,
LOCKING SCREW T10 FULL TREAD 3.5MM L14mm,2009364,CDM,270,RC,,,outpatient,,,617,308.5,,598.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,370.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,555.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,555.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,370.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,448.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,421.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,370.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,498.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,498.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,546.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,409.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,499.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,567.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,586.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,598.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,401.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,370.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,555.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,370.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,370.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,555.3,
LOCKING SCREW T10 FULL TREAD 3.5MM L16mm,2009365,CDM,278,RC,,,outpatient,,,614,307,,595.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,368.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,552.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,552.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,368.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,446.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,419.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,368.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,495.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,495.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,544.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,407.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,497.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,564.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,583.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,595.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,399.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,368.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,368.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,368.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,552.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,368.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,368.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,552.6,
LOCKING SCREW T10 FULL TREAD 3.5MM L18mm,2009366,CDM,278,RC,,,outpatient,,,612.5,306.25,,594.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,551.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,551.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,445.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,418.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,494.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,494.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,542.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,406.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,496.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,563.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,581.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,594.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,398.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,551.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,551.25,
LOCKING SCREW T10 FULL TREAD 3.5MM L20mm,2009367,CDM,270,RC,,,outpatient,,,616.5,308.25,,598.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,369.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,554.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,554.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,369.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,448.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,420.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,369.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,497.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,497.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,546.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,408.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,499.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,567.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,585.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,598.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,369.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,369.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,369.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,554.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,369.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,369.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,554.85,
LOCKING SCREW T10 FULL TREAD 3.5MM L22mm,2009368,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 3.5MM L24mm,2009369,CDM,270,RC,,,outpatient,,,594.75,297.38,,576.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,356.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,535.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,535.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,356.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,432.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,405.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,356.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,480.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,480.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,527.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,394.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,481.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,547.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,565.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,576.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,386.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,356.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,356.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,356.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,535.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,356.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,356.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,535.28,
LOCKING SCREW T10 FULL TREAD 3.5MM L26mm,2009370,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 3.5MM L28mm,2009371,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 3.5MM L30mm,2009372,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 3.5MM L32mm,2009373,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 3.5MM L34mm,2009374,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 3.5MM L36mm,2009375,CDM,270,RC,,,outpatient,,,594.75,297.38,,576.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,356.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,535.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,535.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,356.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,432.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,405.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,356.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,480.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,480.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,527.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,394.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,481.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,547.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,565.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,576.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,386.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,356.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,356.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,356.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,535.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,356.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,356.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,535.28,
LOCKING SCREW T10 FULL TREAD 3.5MM L38mm,2009376,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 3.5MM L40mm,2009377,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 3.5MM L42mm,2009378,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 3.5MM L44mm,2009379,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 3.5MM L46mm,2009380,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 3.5MM L48mm,2009381,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 3.5MM L50mm,2009382,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 3.5MM L55mm,2009383,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 3.5MM L60mm,2009384,CDM,270,RC,,,outpatient,,,157.5,78.75,,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.75,
LOCKING SCREW T10 FULL TREAD 3.5MM L65mm,2009385,CDM,270,RC,,,outpatient,,,612.5,306.25,,594.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,551.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,551.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,445.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,418.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,494.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,494.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,542.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,406.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,496.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,563.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,581.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,594.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,398.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,551.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,551.25,
LOCKING SCREW T10 FULL TREAD 3.5MM L70mm,2009386,CDM,270,RC,,,outpatient,,,612.5,306.25,,594.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,551.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,551.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,445.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,418.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,494.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,494.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,542.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,406.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,496.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,563.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,581.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,594.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,398.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,551.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,551.25,
BONE SCREW T10 F/T2.7 L8MM,2009387,CDM,270,RC,,,outpatient,,,333.5,166.75,,323.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,300.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,300.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,227.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,269.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,295.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,221.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,270.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,306.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,316.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,323.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,216.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,300.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,300.15,
BONE SCREW T10 F/T2.7 L10MM,2009388,CDM,270,RC,,,outpatient,,,335.5,167.75,,325.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,301.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,301.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,244.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,228.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,270.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,270.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,297.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,222.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,271.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,308.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,318.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,325.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,218.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,301.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,301.95,
BONE SCREW T10 F/T2.7 L12MM,2009389,CDM,270,RC,,,outpatient,,,202,101,,195.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,181.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,181.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.98,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,137.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,163.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,178.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,133.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,163.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,185.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,191.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,195.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,181.8,
BONE SCREW T10 F/T2.7 L14MM,2009390,CDM,278,RC,,,outpatient,,,202,101,,195.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,181.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,181.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.98,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,137.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,163.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,178.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,133.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,163.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,185.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,191.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,195.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,181.8,
BONE SCREW T10 F/T2.7 L16MM,2009391,CDM,270,RC,,,outpatient,,,202,101,,195.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,181.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,181.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.98,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,137.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,163.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,178.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,133.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,163.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,185.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,191.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,195.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,181.8,
BONE SCREW T10 F/T2.7 L18MM,2009392,CDM,278,RC,,,outpatient,,,612.5,306.25,,594.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,551.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,551.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,445.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,418.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,494.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,494.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,542.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,406.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,496.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,563.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,581.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,594.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,398.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,551.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,367.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,551.25,
BONE SCREW T10 F/T2.7 L20MM,2009393,CDM,270,RC,,,outpatient,,,333.25,166.63,,323.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,199.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,299.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,299.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,199.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,227.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,199.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,269,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,295.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,220.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,269.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,306.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,316.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,323.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,216.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,199.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,199.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,199.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,299.93,
BONE SCREW T10 F/T2.7 L22MM,2009394,CDM,270,RC,,,outpatient,,,336.25,168.13,,326.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,302.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,302.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,244.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,229.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,271.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,297.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,222.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,272.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,309.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,319.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,326.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,218.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,302.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,302.63,
BONE SCREW T10 F/T2.7 L24MM,2009395,CDM,270,RC,,,outpatient,,,594.75,297.38,,576.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,356.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,535.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,535.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,356.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,432.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,405.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,356.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,480.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,480.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,527.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,394.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,481.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,547.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,565.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,576.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,386.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,356.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,356.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,356.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,535.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,356.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,356.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,535.28,
BONE SCREW T10 F/T2.7 L26MM,2009396,CDM,270,RC,,,outpatient,,,338.25,169.13,,328.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,304.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,304.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,246.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,230.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,273.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,299.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,224.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,273.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,311.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,321.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,328.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,219.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,304.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,304.43,
BONE SCREW T10 F/T2.7 L28MM,2009397,CDM,270,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,90,
BONE SCREW T10 F/T2.7 L30MM,2009398,CDM,270,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,90,
BONE SCREW T10 F/T2.7 L32MM,2009399,CDM,270,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,90,
BONE SCREW T10 F/T2.7 L34MM,2009400,CDM,278,RC,,,outpatient,,,333.5,166.75,,323.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,300.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,300.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,227.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,269.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,295.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,221.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,270.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,306.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,316.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,323.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,216.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,300.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,300.15,
BONE SCREW T10 F/T2.7 L36MM,2009401,CDM,270,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,90,
BONE SCREW T10 F/T2.7 L38MM,2009402,CDM,270,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,90,
BONE SCREW T10 F/T2.7 L40MM,2009403,CDM,270,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,90,
BONE SCREW T10 F/T2.7 L42MM,2009404,CDM,270,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,90,
BONE SCREW T10 F/T2.7 L44MM,2009405,CDM,270,RC,,,outpatient,,,336.25,168.13,,326.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,302.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,302.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,244.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,229.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,271.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,297.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,222.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,272.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,309.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,319.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,326.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,218.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,302.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,302.63,
BONE SCREW T10 F/T2.7 L46MM,2009406,CDM,270,RC,,,outpatient,,,336.25,168.13,,326.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,302.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,302.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,244.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,229.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,271.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,297.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,222.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,272.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,309.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,319.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,326.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,218.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,302.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,302.63,
BONE SCREW T10 F/T2.7 L48MM,2009407,CDM,270,RC,,,outpatient,,,329.5,164.75,,319.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,296.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,296.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,239.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,224.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,265.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,265.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,291.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,218.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,266.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,303.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,313.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,319.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,214.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,296.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,296.55,
BONE SCREW T10 F/T2.7 L50MM,2009408,CDM,270,RC,,,outpatient,,,333.5,166.75,,323.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,300.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,300.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,227.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,269.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,295.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,221.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,270.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,306.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,316.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,323.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,216.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,300.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,300.15,
BONE SCREW T10 F/T2.7 L55MM,2009409,CDM,270,RC,,,outpatient,,,333.5,166.75,,323.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,300.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,300.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,227.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,269.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,295.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,221.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,270.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,306.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,316.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,323.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,216.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,300.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,300.15,
BONE SCREW T10 F/T2.7 L60MM,2009410,CDM,270,RC,,,outpatient,,,333.5,166.75,,323.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,300.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,300.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,227.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,269.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,295.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,221.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,270.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,306.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,316.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,323.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,216.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,300.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,300.15,
BONE SCREW T10 F/T2.7 L65MM,2009411,CDM,270,RC,,,outpatient,,,333.5,166.75,,323.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,300.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,300.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,227.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,269.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,295.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,221.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,270.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,306.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,316.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,323.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,216.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,300.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,300.15,
BONE SCREW T10 F/T2.7 L70MM,2009412,CDM,270,RC,,,outpatient,,,333.5,166.75,,323.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,300.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,300.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,227.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,269.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,295.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,221.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,270.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,306.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,316.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,323.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,216.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,300.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,200.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,300.15,
DRILL BIT AO DIA 2.0MM/135MM,2009413,CDM,270,RC,,,outpatient,,,549.5,274.75,,533.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,329.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,494.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,494.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,329.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,399.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,375.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,329.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,443.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,443.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,486.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,364.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,445.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,505.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,522.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,533.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,357.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,329.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,329.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,329.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,494.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,329.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,329.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,494.55,
DRILL BIT AO DIA 2.6MM/135MM,2009414,CDM,270,RC,,,outpatient,,,329.5,164.75,,319.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,296.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,296.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,239.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,224.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,265.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,265.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,291.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,218.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,266.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,303.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,313.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,319.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,214.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,296.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,296.55,
OVERDRILL  AO DIA 3.5MM/122MM,2009415,CDM,270,RC,,,outpatient,,,329.5,164.75,,319.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,296.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,296.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,239.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,224.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,265.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,265.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,291.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,218.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,266.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,303.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,313.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,319.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,214.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,296.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,296.55,
OVERDRILL  AO DIA 2.7MM/122MM,2009416,CDM,270,RC,,,outpatient,,,549.5,274.75,,533.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,329.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,494.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,494.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,329.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,399.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,375.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,329.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,443.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,443.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,486.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,364.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,445.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,505.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,522.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,533.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,357.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,329.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,329.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,329.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,494.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,329.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,329.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,494.55,
OVERDRILL  AO DIA 2.4MM/122MM,2009417,CDM,270,RC,,,outpatient,,,545,272.5,,528.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,327,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,490.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,490.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,327,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,396.54,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,371.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,327,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,439.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,439.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,482.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,361.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,441.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,501.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,517.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,528.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,354.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,327,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,327,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,327,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,490.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,327,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,327,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,490.5,
K WIRE 22MM W/STOP/10SCREW HEAD,2009418,CDM,278,RC,,,outpatient,,,321.25,160.63,,311.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,289.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,289.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,233.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,219.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,259.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,284.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,212.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,260.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,295.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,305.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,311.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,208.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,289.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,289.13,
SPEED GUIDE DRILL AO DIA 2.0MM/L30,2009419,CDM,270,RC,,,outpatient,,,180,90,,174.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54,30,,,percent of total billed charges,Pays at 30% of total billed charges,162,90,,,percent of total billed charges,Pays at 90% of total billed charges,162,90,,,percent of total billed charges,Pays at 90% of total billed charges,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,122.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,145.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,159.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,119.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,145.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,165.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,171,95,,,percent of total billed charges,Pays at 95% of total billed charges,174.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,117,65,,,percent of total billed charges,Pays at 65% of total billed charges,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162,90,,,percent of total billed charges,Pays at 90% of total billed charges,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,162,
SPEED GUIDE DRILL AO DIA 2.0MM/L30,2009420,CDM,270,RC,,,outpatient,,,180,90,,174.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54,30,,,percent of total billed charges,Pays at 30% of total billed charges,162,90,,,percent of total billed charges,Pays at 90% of total billed charges,162,90,,,percent of total billed charges,Pays at 90% of total billed charges,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,122.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,145.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,159.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,119.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,145.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,165.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,171,95,,,percent of total billed charges,Pays at 95% of total billed charges,174.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,117,65,,,percent of total billed charges,Pays at 65% of total billed charges,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162,90,,,percent of total billed charges,Pays at 90% of total billed charges,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,162,
SPEED GUIDE DRILL AO DIA 2.6MM/L30,2009421,CDM,270,RC,,,outpatient,,,180,90,,174.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54,30,,,percent of total billed charges,Pays at 30% of total billed charges,162,90,,,percent of total billed charges,Pays at 90% of total billed charges,162,90,,,percent of total billed charges,Pays at 90% of total billed charges,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,122.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,145.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,159.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,119.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,145.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,165.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,171,95,,,percent of total billed charges,Pays at 95% of total billed charges,174.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,117,65,,,percent of total billed charges,Pays at 65% of total billed charges,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162,90,,,percent of total billed charges,Pays at 90% of total billed charges,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,162,
DRILL BIT AO DIA 2.0MM/135 SCALED,2009422,CDM,278,RC,,,outpatient,,,329.5,164.75,,319.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,296.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,296.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,239.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,224.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,265.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,265.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,291.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,218.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,266.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,303.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,313.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,319.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,214.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,296.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,296.55,
OVERDRILL  AO DIA 2.7MM/122MM,2009423,CDM,270,RC,,,outpatient,,,139.75,69.88,,135.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,113.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,128.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,135.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,125.78,
TAP AO FOR 3.5MM SCREW,2009424,CDM,270,RC,,,outpatient,,,136.75,68.38,,132.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,123.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,90.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,110.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,125.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,129.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,132.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.08,
TAP AO FOR 2.7MM SCREW,2009425,CDM,270,RC,,,outpatient,,,1044.75,522.38,,1013.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,626.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,940.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,940.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,626.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,760.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,713.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,626.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,843.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,843.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,925.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,692.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,846.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,961.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,992.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,1013.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,679.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,626.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,626.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,626.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,940.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,626.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,626.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,940.28,
TAP AO FOR 2.4MM SCREW,2009426,CDM,270,RC,,,outpatient,,,136.75,68.38,,132.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,123.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,90.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,110.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,125.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,129.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,132.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.08,
BONE SCREW T18 P/T2.7 L16MM,2009427,CDM,270,RC,,,outpatient,,,82.5,41.25,,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,
BONE SCREW T8 P/T2.7 L18MM,2009428,CDM,270,RC,,,outpatient,,,82.5,41.25,,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,
BONE SCREW T8 P/T2.7 L20MM,2009429,CDM,270,RC,,,outpatient,,,82.5,41.25,,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,
BONE SCREW T8 P/T2.7 L22MM,2009430,CDM,270,RC,,,outpatient,,,82.5,41.25,,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,
BONE SCREW T8 P/T2.7 L24MM,2009431,CDM,270,RC,,,outpatient,,,82.5,41.25,,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,
BONE SCREW T8 P/T2.7 L26MM,2009432,CDM,270,RC,,,outpatient,,,82.5,41.25,,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,
LOCKING PEG T8 2.0MM/L16MM,2009433,CDM,278,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
LOCKING PEG T8 2.0MM/L18MM,2009434,CDM,278,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
LOCKING PEG T8 2.0MM/L20MM,2009435,CDM,278,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
LOCKING PEG T8 2.0MM/L22MM,2009436,CDM,278,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
LOCKING PEG T8 2.0MM/L24MM,2009437,CDM,278,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
LOCKING PEG T8 2.0MM/L26MM,2009438,CDM,278,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
DISTAL LATERAL FIBULA PLATE 3 HOLE,2009439,CDM,278,RC,,,outpatient,,,2170.5,1085.25,,2105.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,1302.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1953.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,1953.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,1302.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1579.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1481.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1302.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1752.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1752.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1923.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1439.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1758.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1996.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,2061.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,2105.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,1410.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,1302.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1302.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1302.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1953.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,1302.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1302.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1953.45,
DISTAL LATERAL FIBULA PLATE 4 HOLE,2009440,CDM,270,RC,,,outpatient,,,1290,645,,1251.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,774,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,387,30,,,percent of total billed charges,Pays at 30% of total billed charges,1161,90,,,percent of total billed charges,Pays at 90% of total billed charges,1161,90,,,percent of total billed charges,Pays at 90% of total billed charges,774,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,938.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,880.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,774,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1041.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1041.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1143.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,855.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1044.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1186.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,1225.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,1251.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,838.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,774,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,774,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,774,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1161,90,,,percent of total billed charges,Pays at 90% of total billed charges,774,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,774,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1161,
DISTAL LATERAL FIBULA PLATE 5 HOLE,2009441,CDM,270,RC,,,outpatient,,,2214,1107,,2147.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,1328.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,664.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,1992.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,1992.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,1328.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1610.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1511.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1328.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1787.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1787.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1961.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1467.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1793.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2036.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,2103.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,2147.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,1439.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,1328.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1328.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1328.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1992.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,1328.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1328.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1992.6,
DISTAL LATERAL FIBULA PLATE 6 HOLE,2009442,CDM,270,RC,,,outpatient,,,2269.5,1134.75,,2201.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,1361.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,680.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,2042.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,2042.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,1361.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1651.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1548.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1361.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1831.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1831.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2011,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1504.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1838.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2087.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,2156.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,2201.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,1475.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,1361.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1361.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1361.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2042.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,1361.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1361.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2042.55,
DISTAL LATERAL FIBULA PLATE 7 HOLE,2009443,CDM,270,RC,,,outpatient,,,2446.5,1223.25,,2373.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,1467.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,733.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,2201.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,2201.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,1467.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1780.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1669.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1467.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1974.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1974.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2167.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1622.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1981.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2250.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,2324.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,2373.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,1590.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,1467.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1467.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1467.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2201.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,1467.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1467.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2201.85,
DISTAL LATERAL FIBULA PLATE 8 HOLE,2009444,CDM,270,RC,,,outpatient,,,292.5,146.25,,283.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,175.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,263.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,263.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,175.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,199.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,175.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,236.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,236.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,259.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,193.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,236.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,269.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,277.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,283.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,190.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,175.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,175.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,175.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,263.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,175.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,175.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,263.25,
DISTAL LATERAL FIBULA PLATE 9 HOLE,2009445,CDM,270,RC,,,outpatient,,,2462.75,1231.38,,2388.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,1477.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,738.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2216.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2216.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1477.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1791.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1680.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1477.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1987.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1987.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2182.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1632.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1994.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2265.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,2339.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2388.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,1600.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1477.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1477.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1477.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2216.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1477.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1477.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2216.48,
SCREW CANNULATED TI 4.0X24MM,2009446,CDM,278,RC,,,outpatient,,,144.5,72.25,,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.05,
SCREW CANNULATED TI 4.0X26MM,2009447,CDM,278,RC,,,outpatient,,,144.5,72.25,,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.05,
SCREW CANNULATED TI 4.0X28MM,2009448,CDM,278,RC,,,outpatient,,,144.5,72.25,,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.05,
SCREW CANNULATED TI 4.0X30MM,2009449,CDM,278,RC,,,outpatient,,,144.5,72.25,,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.05,
SCREW CANNULATED TI 4.0X32MM,2009450,CDM,278,RC,,,outpatient,,,144.5,72.25,,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.05,
SCREW CANNULATED TI 4.0X34MM,2009451,CDM,278,RC,,,outpatient,,,144.5,72.25,,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.05,
SCREW CANNULATED TI 4.0X36MM,2009452,CDM,278,RC,,,outpatient,,,144.5,72.25,,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.05,
SCREW CANNULATED TI 4.0X38MM,2009453,CDM,278,RC,,,outpatient,,,144.5,72.25,,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.05,
SCREW CANNULATED TI 4.0X40MM,2009454,CDM,278,RC,,,outpatient,,,751.5,375.75,,728.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,450.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,676.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,676.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,450.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,546.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,512.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,450.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,606.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,606.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,665.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,498.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,608.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,691.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,713.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,728.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,488.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,450.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,450.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,450.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,676.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,450.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,450.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,676.35,
SCREW CANNULATED TI 4.0X42MM,2009455,CDM,278,RC,,,outpatient,,,144.5,72.25,,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.05,
SCREW CANNULATED TI 4.0X44MM,2009456,CDM,278,RC,,,outpatient,,,704.25,352.13,,683.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,422.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,633.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,633.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,422.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,512.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,480.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,422.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,568.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,568.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,624.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,466.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,570.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,647.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,669.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,683.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,457.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,422.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,422.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,422.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,633.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,422.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,422.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,633.83,
SCREW CANNULATED TI 4.0X46MM,2009457,CDM,278,RC,,,outpatient,,,144.5,72.25,,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.05,
SCREW CANNULATED TI 4.0X48MM,2009458,CDM,278,RC,,,outpatient,,,144.5,72.25,,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.05,
SCREW CANNULATED TI 4.0X50MM,2009459,CDM,278,RC,,,outpatient,,,614.5,307.25,,596.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,368.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,553.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,553.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,368.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,447.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,419.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,368.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,496.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,496.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,544.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,407.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,497.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,565.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,583.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,596.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,399.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,368.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,368.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,368.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,553.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,368.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,368.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,553.05,
SCREW CANNULATED TI 4.0X55MM,2009460,CDM,278,RC,,,outpatient,,,350.5,175.25,,339.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,210.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,315.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,315.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,255.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,239.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,210.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,282.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,282.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,310.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,232.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,283.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,322.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,332.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,339.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,227.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,210.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,315.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,210.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,315.45,
SCREW CANNULATED TI 4.0X60MM,2009461,CDM,278,RC,,,outpatient,,,144.5,72.25,,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.05,
SCREW CANNULATED TI 4.0X65MM,2009462,CDM,278,RC,,,outpatient,,,144.5,72.25,,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.05,
SCREW CANNULATED TI 4.0X70MM,2009463,CDM,278,RC,,,outpatient,,,144.5,72.25,,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.05,
WASHER TI  ASNIS III 4.0MM,2009464,CDM,278,RC,,,outpatient,,,24.75,12.38,,24.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,90,
TUBULAR PLATE ONE THIRD 2HOLE L23MM,2009465,CDM,278,RC,,,outpatient,,,226,113,,219.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,203.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,154.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,183.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,207.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,214.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,219.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,203.4,
TUBULAR PLATE ONE THIRD 3HOLE L35MM,2009466,CDM,278,RC,,,outpatient,,,226,113,,219.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,203.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,154.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,183.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,207.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,214.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,219.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,203.4,
TUBULAR PLATE ONE THIRD 4 HOLE L47MM,2009467,CDM,278,RC,,,outpatient,,,121.5,60.75,,117.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,109.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,98.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,111.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,115.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,117.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,109.35,
TUBULAR PLATE ONE THIRD 5 HOLE L59MM,2009468,CDM,278,RC,,,outpatient,,,121.5,60.75,,117.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,109.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,98.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,111.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,115.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,117.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,109.35,
TUBULAR PLATE ONE THIRD 6 HOLE L71MM,2009469,CDM,278,RC,,,outpatient,,,121.5,60.75,,117.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,109.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,98.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,111.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,115.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,117.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,109.35,
TUBULAR PLATE ONE THIRD 7 HOLE L83MM,2009470,CDM,278,RC,,,outpatient,,,121.5,60.75,,117.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,109.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,98.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,111.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,115.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,117.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,109.35,
TUBULAR PLATE ONE THIRD 8 HOLE L95MM,2009471,CDM,278,RC,,,outpatient,,,1034,517,,1002.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,620.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,310.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,930.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,930.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,620.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,752.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,705.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,620.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,834.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,834.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,916.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,685.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,837.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,951.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,982.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,1002.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,672.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,620.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,620.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,620.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,930.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,620.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,620.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,930.6,
TUBULAR PLATE ONE THIRD 9 HOLE L107MM,2009472,CDM,278,RC,,,outpatient,,,162.75,81.38,,157.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,111.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,131.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,144.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.48,
TUBULAR PLATE ONE THIRD 10 HOLE L119MM,2009473,CDM,278,RC,,,outpatient,,,162.75,81.38,,157.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,111.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,131.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,144.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.48,
TUBULAR PLATE ONE THIRD 12 HOLE L143MM,2009474,CDM,278,RC,,,outpatient,,,1415.25,707.63,,1372.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,849.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,424.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,1273.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1273.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,849.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1029.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,965.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,849.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1142.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1142.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1254.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,938.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1146.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1302.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1344.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,1372.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,919.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,849.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,849.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,849.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1273.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,849.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,849.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1273.73,
TUBULAR PLATE ONE THIRD 14 HOLE L167MM,2009475,CDM,278,RC,,,outpatient,,,225.5,112.75,,218.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,202.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,153.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,199.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,182.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,207.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,214.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,218.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,135.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,202.95,
TUBULAR PLATE ONE THIRD 14 HOLE L191MM,2009476,CDM,278,RC,,,outpatient,,,225.5,112.75,,218.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,202.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,153.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,199.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,182.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,207.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,214.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,218.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,135.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,202.95,
VARIAX COMPRESSION PLATE N/S 4HOLE,2009477,CDM,278,RC,,,outpatient,,,131.25,65.63,,127.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,118.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,106.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,120.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,124.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,127.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,118.13,
VARIAX COMPRESSION PLATE N/S 5 HOLE,2009478,CDM,278,RC,,,outpatient,,,174.25,87.13,,169.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,156.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,156.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,118.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,140.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,115.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,141.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,160.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,165.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,169.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,156.83,
VARIAX COMPRESSION PLATE N/S 6 HOLE,2009479,CDM,278,RC,,,outpatient,,,174.25,87.13,,169.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,156.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,156.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,118.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,140.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,115.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,141.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,160.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,165.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,169.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,156.83,
VARIAX COMPRESSION PLATE  7 HOLE L90W/LO,2009480,CDM,278,RC,,,outpatient,,,174.25,87.13,,169.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,156.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,156.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,118.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,140.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,115.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,141.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,160.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,165.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,169.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,156.83,
VARIAX COMPRESSION PLATE N/S 8 HOLE,2009481,CDM,278,RC,,,outpatient,,,255.5,127.75,,247.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,229.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,229.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,174.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,169.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,206.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,235.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,242.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,247.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,166.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,229.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,229.95,
VARIAX COMPRESSION PLATE N/S 9 HOLE,2009482,CDM,278,RC,,,outpatient,,,255.5,127.75,,247.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,229.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,229.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,174.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,169.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,206.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,235.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,242.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,247.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,166.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,229.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,229.95,
VARIAX COMPRESSION PLATE N/S 10 HOLE,2009483,CDM,278,RC,,,outpatient,,,255.5,127.75,,247.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,229.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,229.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,174.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,169.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,206.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,235.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,242.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,247.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,166.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,229.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,229.95,
VARIAX COMPRESSION PLATE  7 HOLE/L90W/L,2009484,CDM,278,RC,,,outpatient,,,174.25,87.13,,169.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,156.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,156.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,118.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,140.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,115.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,141.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,160.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,165.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,169.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,156.83,
VARIAX COMPRESSION PLATE  7 HOLE/L91MM,2009485,CDM,278,RC,,,outpatient,,,174.25,87.13,,169.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,156.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,156.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,118.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,140.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,115.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,141.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,160.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,165.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,169.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,156.83,
VARIAX COMPRESSION PLATE B/S4 HOLE,2009486,CDM,278,RC,,,outpatient,,,131.25,65.63,,127.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,118.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,106.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,120.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,124.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,127.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,118.13,
VARIAX COMPRESSION PLATE B/S 5 HOLE,2009487,CDM,278,RC,,,outpatient,,,174.25,87.13,,169.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,156.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,156.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,118.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,140.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,115.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,141.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,160.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,165.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,169.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,156.83,
VARIAX COMPRESSION PLATE B/S 6 HOLE,2009488,CDM,278,RC,,,outpatient,,,1469.5,734.75,,1425.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,881.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,440.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,1322.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,1322.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,881.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1069.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1002.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,881.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1186.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1186.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1302.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,974.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1190.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1351.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,1396.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,1425.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,955.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,881.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,881.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,881.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1322.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,881.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,881.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1322.55,
VARIAX COMPRESSION PLATE 7 HOLE L91,2009489,CDM,278,RC,,,outpatient,,,174.25,87.13,,169.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,156.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,156.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,118.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,140.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,115.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,141.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,160.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,165.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,169.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,156.83,
VARIAX COMPRESSION PLATE B/S 8 HOLE,2009490,CDM,278,RC,,,outpatient,,,255.5,127.75,,247.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,229.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,229.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,174.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,169.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,206.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,235.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,242.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,247.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,166.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,229.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,229.95,
VARIAX COMPRESSION PLATE B/c 9 HOLE,2009491,CDM,278,RC,,,outpatient,,,255.5,127.75,,247.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,229.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,229.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,174.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,169.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,206.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,235.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,242.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,247.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,166.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,229.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,229.95,
VARIAX COMPRESSION PLATE B/c 10 HOLE,2009492,CDM,278,RC,,,outpatient,,,255.5,127.75,,247.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,229.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,229.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,174.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,169.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,206.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,235.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,242.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,247.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,166.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,229.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,153.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,229.95,
VARIAX COMPRESSION PLATE B/c 11 HOLE,2009493,CDM,278,RC,,,outpatient,,,303.75,151.88,,294.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,273.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,273.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,207.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,245.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,245.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,269.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,201.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,246.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,279.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,288.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,294.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,197.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,273.38,
VARIAX COMPRESSION PLATE B/c 12 HOLE,2009494,CDM,270,RC,,,outpatient,,,303.75,151.88,,294.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,273.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,273.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,207.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,245.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,245.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,269.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,201.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,246.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,279.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,288.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,294.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,197.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,273.38,
VARIAX COMPRESSION PLATE B/c 14 HOLE,2009495,CDM,270,RC,,,outpatient,,,303.75,151.88,,294.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,273.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,273.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,207.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,245.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,245.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,269.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,201.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,246.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,279.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,288.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,294.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,197.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,273.38,
CANN 4.0MM TWIST DRILL W/AO,2009496,CDM,278,RC,,,outpatient,,,1135,567.5,,1100.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,681,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,340.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,1021.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,1021.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,681,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,825.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,774.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,681,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,916.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,916.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1005.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,752.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,919.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1044.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,1078.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,1100.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,737.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,681,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,681,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,681,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1021.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,681,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,681,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1021.5,
CANN 2.7MM TWIST DRILL W/AOF,2009497,CDM,270,RC,,,outpatient,,,1074.25,537.13,,1042.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,644.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,966.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,966.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,644.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,781.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,733.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,644.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,867.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,867.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,951.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,712.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,870.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,988.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,1020.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,1042.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,698.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,644.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,644.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,644.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,966.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,644.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,644.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,966.83,
CANN 4.0MM TWIST TAP W/AOF,2009498,CDM,270,RC,,,outpatient,,,151.75,75.88,,147.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,136.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,103.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,122.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,100.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,122.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,139.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,144.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,147.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,136.58,
GUIDE WIRE ASNIS III 1.4X150MM,2009499,CDM,270,RC,,,outpatient,,,164.75,82.38,,159.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,148.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,148.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,112.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,98.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,145.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,109.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,133.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,151.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,156.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,159.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,107.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,98.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,98.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,148.28,
CANN COUNTERSINK 4.0 W/AO FITTING,2009500,CDM,270,RC,,,outpatient,,,134.5,67.25,,130.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,121.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,80.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,108.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,123.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,127.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,130.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,80.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,80.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.05,
STEINMANN PIN SMOOTH 2.5X100MM,2009501,CDM,270,RC,,,outpatient,,,32.5,16.25,,31.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,29.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,29.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,30.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,31.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.5,90,
K WIRE /LENTH/MARKING 0.045'',2009502,CDM,270,RC,,,outpatient,,,103.5,51.75,,100.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,93.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,93.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,70.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,68.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,95.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,98.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,100.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,62.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,93.15,
DORSAL SMARTLOCK PLATE S/RIGHT,2009503,CDM,270,RC,,,outpatient,,,369,184.5,,357.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,332.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,332.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,268.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,251.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,297.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,326.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,244.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,298.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,339.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,350.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,357.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,239.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,332.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,332.1,
DORSAL SMARTLOCK PLATE S/LEFT,2009504,CDM,270,RC,,,outpatient,,,369,184.5,,357.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,332.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,332.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,268.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,251.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,297.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,326.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,244.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,298.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,339.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,350.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,357.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,239.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,332.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,332.1,
DORSAL SMARTLOCK PLATE W/RIGHT,2009505,CDM,270,RC,,,outpatient,,,369,184.5,,357.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,332.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,332.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,268.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,251.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,297.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,326.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,244.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,298.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,339.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,350.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,357.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,239.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,332.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,332.1,
DORSAL SMARTLOCK PLATE W/LEFT,2009506,CDM,270,RC,,,outpatient,,,369,184.5,,357.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,332.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,332.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,268.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,251.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,297.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,326.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,244.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,298.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,339.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,350.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,357.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,239.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,332.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,332.1,
DORSAL SMARTLOCK DR PLATE S/RT/EXLONG,2009507,CDM,270,RC,,,outpatient,,,426,213,,413.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,383.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,383.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,309.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,290.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,343.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,343.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,377.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,282.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,345.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,391.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,404.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,413.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,276.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,383.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,383.4,
DORSAL SMARTLOCK DR PLATE S/LT/EXLONG,2009509,CDM,270,RC,,,outpatient,,,426,213,,413.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,383.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,383.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,309.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,290.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,343.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,343.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,377.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,282.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,345.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,391.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,404.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,413.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,276.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,383.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,383.4,
DORSAL SMARTLOCK DR PLATE W/RT/EXLONG,2009510,CDM,270,RC,,,outpatient,,,426,213,,413.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,383.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,383.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,309.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,290.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,343.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,343.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,377.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,282.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,345.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,391.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,404.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,413.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,276.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,383.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,383.4,
DORSAL SMARTLOCK DR PLATE W/LT/EXLONG,2009511,CDM,270,RC,,,outpatient,,,426,213,,413.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,383.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,383.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,309.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,290.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,343.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,343.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,377.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,282.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,345.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,391.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,404.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,413.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,276.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,383.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,255.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,383.4,
VOLAR SMARTLOCK DR PLATE N/LT,2009512,CDM,278,RC,,,outpatient,,,3086.75,1543.38,,2994.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,1852.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,926.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,2778.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,2778.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,1852.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2245.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2106.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1852.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2491.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2491.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2735.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2046.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2500.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2839.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,2932.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,2994.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,2006.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,1852.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1852.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1852.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2778.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,1852.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1852.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2778.08,
VOLAR SMARTLOCK DR PLATE N/LT/LONG,2009513,CDM,270,RC,,,outpatient,,,418.25,209.13,,405.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,376.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,376.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,304.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,285.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,337.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,337.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,370.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,277.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,338.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,384.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,397.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,405.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,271.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,376.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,376.43,
VOLAR SMARTLOCK DR PLATE S/LT,2009514,CDM,270,RC,,,outpatient,,,362.25,181.13,,351.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,217.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,326.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,326.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,217.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,263.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,247.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,217.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,292.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,292.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,320.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,240.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,293.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,333.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,344.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,351.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,235.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,217.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,217.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,217.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,326.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,217.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,217.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,326.03,
VOLAR SMARTLOCK DR PLATE S/LT/LONG,2009515,CDM,270,RC,,,outpatient,,,3564,1782,,3457.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,2138.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1069.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,3207.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,3207.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2138.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2593.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2432.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2138.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2876.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2876.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3158.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2362.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2886.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3278.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,3385.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,3457.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,2316.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,2138.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2138.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2138.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3207.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2138.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2138.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3207.6,
VOLAR SMARTLOCK DR PLATE N/RT,2009516,CDM,270,RC,,,outpatient,,,3086.5,1543.25,,2993.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1851.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,925.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,2777.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,2777.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,1851.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2245.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2106.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1851.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2491.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2491.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2734.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2046.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2500.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2839.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,2932.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,2993.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,2006.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,1851.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1851.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1851.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2777.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,1851.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1851.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2777.85,
VOLAR SMARTLOCK DR PLATE S/RT,2009517,CDM,270,RC,,,outpatient,,,418.25,209.13,,405.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,376.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,376.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,304.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,285.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,337.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,337.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,370.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,277.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,338.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,384.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,397.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,405.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,271.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,376.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,376.43,
VOLAR SMARTLOCK DR PLATE S/RT,2009518,CDM,270,RC,,,outpatient,,,3086.75,1543.38,,2994.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,1852.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,926.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,2778.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,2778.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,1852.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2245.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2106.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1852.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2491.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2491.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2735.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2046.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2500.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2839.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,2932.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,2994.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,2006.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,1852.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1852.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1852.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2778.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,1852.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1852.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2778.08,
VOLAR SMARTLOCK DR PLATE S/RT /LONG,2009519,CDM,270,RC,,,outpatient,,,418.25,209.13,,405.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,376.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,376.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,304.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,285.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,337.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,337.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,370.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,277.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,338.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,384.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,397.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,405.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,271.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,376.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,376.43,
RADIAL COL SMARTLOCK  PLATE SHORT,2009520,CDM,270,RC,,,outpatient,,,2232,1116,,2165.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,1339.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,669.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,2008.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2008.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1339.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1624,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1523.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1339.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1801.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1801.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1977.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1479.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1807.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2053.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,2120.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,2165.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,1450.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,1339.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1339.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1339.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2008.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1339.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1339.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2008.8,
RADIAL COL SMARTLOCK  PLATE LONG,2009521,CDM,270,RC,,,outpatient,,,2299,1149.5,,2230.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,1379.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,689.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,2069.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,2069.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,1379.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1672.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1569.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1379.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1855.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1855.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2037.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1524.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1862.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2115.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,2184.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,2230.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,1494.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,1379.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1379.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1379.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2069.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,1379.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1379.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2069.1,
ULR COL SMARTLOCK  PLATE S/RT,2009522,CDM,270,RC,,,outpatient,,,269.5,134.75,,261.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,242.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,242.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,183.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,217.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,217.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,238.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,178.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,218.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,247.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,256.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,261.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,175.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,242.55,
ULR COL SMARTLOCK  PLATE S/LT,2009523,CDM,270,RC,,,outpatient,,,269.5,134.75,,261.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,242.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,242.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,183.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,217.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,217.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,238.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,178.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,218.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,247.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,256.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,261.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,175.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,242.55,
ULR COL SMARTLOCK  PLATE LONG/RT,2009524,CDM,270,RC,,,outpatient,,,269.5,134.75,,261.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,242.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,242.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,183.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,217.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,217.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,238.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,178.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,218.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,247.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,256.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,261.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,175.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,242.55,
ULR COL SMARTLOCK  PLATE LONG/LT,2009525,CDM,270,RC,,,outpatient,,,269.5,134.75,,261.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,242.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,242.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,183.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,217.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,217.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,238.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,178.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,218.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,247.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,256.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,261.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,175.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,242.55,
VOLAR DR PLATE RROW LT/8HOLE EX SHORT,2009526,CDM,270,RC,,,outpatient,,,386.75,193.38,,375.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,348.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,348.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,281.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,263.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,312.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,312.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,342.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,256.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,313.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,355.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,367.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,375.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,251.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,348.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,348.08,
VOLAR DR PLATE RROW RT/8HOLE EX SHORT,2009527,CDM,270,RC,,,outpatient,,,386.75,193.38,,375.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,348.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,348.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,281.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,263.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,312.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,312.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,342.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,256.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,313.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,355.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,367.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,375.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,251.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,348.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,348.08,
VOLAR DR PLATE INTERMEDIATE LT/10HOLE,2009528,CDM,270,RC,,,outpatient,,,3202.5,1601.25,,3106.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,1921.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,960.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,2882.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,2882.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1921.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2330.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2185.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1921.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2585.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2585.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2837.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2123.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2594.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2946.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,3042.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,3106.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,2081.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,1921.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1921.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1921.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2882.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1921.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1921.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2882.25,
VOLAR DR PLATE INTERMEDIATE LT/11HOLE,2009529,CDM,270,RC,,,outpatient,,,386.75,193.38,,375.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,348.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,348.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,281.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,263.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,312.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,312.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,342.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,256.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,313.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,355.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,367.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,375.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,251.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,348.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,348.08,
VOLAR DR PLATE INTERMEDIATE LT/14HOLE,2009530,CDM,270,RC,,,outpatient,,,445.75,222.88,,432.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,267.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,401.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,401.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,267.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,324.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,304.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,267.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,359.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,359.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,394.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,295.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,361.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,410.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,423.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,432.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,289.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,267.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,267.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,267.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,401.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,267.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,267.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,401.18,
VOLAR DR PLATE INTERMEDIATE RT/10HOLE,2009531,CDM,270,RC,,,outpatient,,,386.75,193.38,,375.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,348.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,348.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,281.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,263.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,312.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,312.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,342.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,256.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,313.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,355.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,367.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,375.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,251.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,348.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,348.08,
VOLAR DR PLATE INTERMEDIATE RT/11HOLE,2009532,CDM,270,RC,,,outpatient,,,3298.5,1649.25,,3199.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,1979.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,989.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,2968.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2968.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,1979.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2399.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2251.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1979.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2662.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2662.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2922.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2186.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2671.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3034.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,3133.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,3199.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,2144.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,1979.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1979.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1979.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2968.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,1979.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1979.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2968.65,
VOLAR DR PLATE INTERMEDIATE RT/14HOLE LO,2009533,CDM,270,RC,,,outpatient,,,445.75,222.88,,432.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,267.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,401.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,401.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,267.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,324.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,304.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,267.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,359.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,359.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,394.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,295.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,361.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,410.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,423.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,432.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,289.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,267.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,267.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,267.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,401.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,267.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,267.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,401.18,
VOLAR DR PLATE INTERMEDIATE LT/10HOLE,2009534,CDM,278,RC,,,outpatient,,,2109.75,1054.88,,2046.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,1265.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,632.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,1898.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,1898.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,1265.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1535.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1439.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1265.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1702.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1702.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1869.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1398.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1708.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1940.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,2004.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,2046.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,1371.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,1265.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1265.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1265.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1898.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,1265.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1265.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1898.78,
VOLAR DR PLATE INTERMEDIATE RT/10HOLE,2009535,CDM,270,RC,,,outpatient,,,386.75,193.38,,375.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,348.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,348.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,281.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,263.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,312.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,312.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,342.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,256.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,313.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,355.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,367.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,375.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,251.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,348.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,232.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,348.08,
K WIRE W/17MM STOP,2009536,CDM,270,RC,,,outpatient,,,143.5,71.75,,139.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,129.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,129.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,97.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,116.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,136.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,139.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,129.15,
TUBE DIST/COMP MRI COMPACT HII,2009537,CDM,270,RC,,,outpatient,,,222.25,111.13,,215.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,133.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,200.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,151.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,133.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,179.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,179.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,196.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,147.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,180.02,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,204.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,211.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,215.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,144.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,133.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,133.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,200.03,
ROD TO ROD COUPLING5/5MM MRI COMPACT HII,2009538,CDM,270,RC,,,outpatient,,,166.25,83.13,,161.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,149.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,134.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,152.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,157.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,161.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,149.63,
PIN TO ROD COUPLING3-4/5MM MRI COMPACT,2009539,CDM,270,RC,,,outpatient,,,166.25,83.13,,161.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,149.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,134.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,152.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,157.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,161.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,149.63,
ROD TO ROD COUPLING5/8MM MRI COMPACT HII,2009540,CDM,270,RC,,,outpatient,,,236.5,118.25,,229.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,141.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,212.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,212.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,161.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,141.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,190.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,209.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,156.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,191.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,217.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,224.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,229.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,153.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,141.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,141.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,212.85,
ROD TO TUB COUPLING MRI COMPACT HII,2009541,CDM,270,RC,,,outpatient,,,138,69,,133.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,124.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,124.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,94.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,111.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,122.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,131.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,82.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,124.2,
PIN CLAMP 4 HOLEMRI COMPACT HII,2009542,CDM,270,RC,,,outpatient,,,200.75,100.38,,194.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,180.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,180.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,137.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,177.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,133.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,162.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,184.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,190.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,194.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,130.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,180.68,
ANGLES POST 30 T-MRI COMPACT HII,2009543,CDM,270,RC,,,outpatient,,,73.75,36.88,,71.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,66.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,66.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,50.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,44.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,59.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,48.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,59.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,67.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,70.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,71.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,44.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,44.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.25,90,
PERIARTICULAR PIN/CLAMP MRI COMPACT HII,2009544,CDM,270,RC,,,outpatient,,,200.75,100.38,,194.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,180.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,180.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,137.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,177.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,133.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,162.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,184.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,190.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,194.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,130.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,120.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,180.68,
APEX HALF PIN/CLAMP30THR 4X90,2009545,CDM,270,RC,,,outpatient,,,108.25,54.13,,105,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,95.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,71.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,87.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,99.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,102.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,105,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,97.43,
MOD HALF PIN4x120 35 cont,2009546,CDM,270,RC,,,outpatient,,,108.25,54.13,,105,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,95.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,71.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,87.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,99.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,102.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,105,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,97.43,
MOD HALF PIN4x150 50cont,2009547,CDM,270,RC,,,outpatient,,,108.25,54.13,,105,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,95.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,71.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,87.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,99.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,102.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,105,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,97.43,
APEX  S/D HALF PIN 3x110 25 THR Cont,2009548,CDM,270,RC,,,outpatient,,,78.75,39.38,,76.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,70.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,53.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,63.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,72.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,74.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,76.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,90,
APEX  S/D HALF PIN 3x60 10 THR Cont,2009549,CDM,270,RC,,,outpatient,,,78.75,39.38,,76.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,70.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,53.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,63.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,72.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,74.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,76.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,90,
APEX  S/D HALF PIN 3x80 20 THR Cont,2009550,CDM,270,RC,,,outpatient,,,78.75,39.38,,76.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,70.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,53.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,63.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,72.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,74.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,76.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,90,
MRI CONNECTING ROD 5MMX65MM HII COMP,2009551,CDM,270,RC,,,outpatient,,,96.5,48.25,,93.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,86.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,65.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,63.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,78.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,88.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,91.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,93.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.9,90,
MRI CONNECTING ROD 5MMX100MM HII COMP,2009552,CDM,270,RC,,,outpatient,,,96.5,48.25,,93.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,86.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,65.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,63.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,78.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,88.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,91.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,93.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.9,90,
MRI CONNECTING ROD 5MMX150MM HII COMP,2009553,CDM,270,RC,,,outpatient,,,96.5,48.25,,93.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,86.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,65.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,63.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,78.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,88.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,91.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,93.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.9,90,
MRI CONNECTING ROD 5MMX200MM HII COMP,2009554,CDM,270,RC,,,outpatient,,,96.5,48.25,,93.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,86.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,65.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,63.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,78.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,88.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,91.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,93.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.9,90,
MRI CONNECTING ROD 5MMX250MM HII COMP,2009555,CDM,270,RC,,,outpatient,,,96.5,48.25,,93.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,86.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,65.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,63.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,78.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,88.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,91.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,93.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.9,90,
MRI CONNECTING ROD 5MMX300MM HII COMP,2009556,CDM,270,RC,,,outpatient,,,112.5,56.25,,109.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,101.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,103.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,109.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,101.25,
GRAY PT DRILL 2.2MMX100MM,2009557,CDM,270,RC,,,outpatient,,,91.5,45.75,,88.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,82.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,62.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,60.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,74.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,84.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,86.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,88.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.9,90,
GRAY PT DRILL 3.2MMX200MM,2009558,CDM,270,RC,,,outpatient,,,91.5,45.75,,88.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,82.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,62.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,60.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,74.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,84.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,86.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,88.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.9,90,
V 40 COCR LFIT HEAD 26MM/-3,2009559,CDM,270,RC,,,outpatient,,,313.25,156.63,,303.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,281.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,281.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,213.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,252.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,277.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,207.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,253.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,288.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,297.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,303.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,203.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,281.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,281.93,
V 40 COCR LFIT HEAD 26MM/0,2009560,CDM,278,RC,,,outpatient,,,1279.5,639.75,,1241.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,767.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1151.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,1151.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,767.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,930.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,873.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,767.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1032.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1032.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1133.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,848.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1036.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1177.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,1215.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,1241.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,831.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,767.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,767.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,767.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1151.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,767.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,767.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1151.55,
V 40 COCR LFIT HEAD 26MM/+4,2009561,CDM,270,RC,,,outpatient,,,313.25,156.63,,303.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,281.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,281.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,213.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,252.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,277.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,207.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,253.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,288.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,297.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,303.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,203.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,281.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,281.93,
V 40 COCR LFIT HEAD 26MM/+8,2009562,CDM,270,RC,,,outpatient,,,313.25,156.63,,303.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,281.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,281.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,213.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,252.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,277.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,207.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,253.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,288.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,297.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,303.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,203.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,281.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,281.93,
V 40 COCR LFIT HEAD 26MM/+12,2009563,CDM,270,RC,,,outpatient,,,313.25,156.63,,303.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,281.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,281.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,213.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,252.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,277.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,207.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,253.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,288.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,297.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,303.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,203.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,281.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,187.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,281.93,
MODULAR SHAFT 450MM STERILE AO FIT,2009564,CDM,270,RC,,,outpatient,,,626.75,313.38,,607.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,376.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,564.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,564.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,376.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,456.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,427.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,376.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,505.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,505.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,555.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,415.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,507.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,576.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,595.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,607.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,407.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,376.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,376.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,376.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,564.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,376.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,376.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,564.08,
GUIDE WIRE BALL TIP 3.0X800MM STERILE,2009565,CDM,270,RC,,,outpatient,,,419.5,209.75,,406.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,251.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,377.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,377.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,251.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,305.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,286.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,251.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,338.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,338.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,371.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,278.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,339.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,385.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,398.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,406.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,272.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,251.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,377.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,251.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,251.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,377.55,
UHR BIPOLOR 26X41MM,2009567,CDM,270,RC,,,outpatient,,,424,212,,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,289.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,375.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,281.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,343.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,390.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,402.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,275.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,381.6,
UHR BIPOLOR 26X42MM,2009568,CDM,270,RC,,,outpatient,,,424,212,,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,289.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,375.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,281.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,343.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,390.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,402.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,275.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,381.6,
UHR BIPOLOR 26X44MM,2009569,CDM,270,RC,,,outpatient,,,424,212,,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,289.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,375.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,281.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,343.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,390.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,402.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,275.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,381.6,
UHR BIPOLOR 26X43MM,2009570,CDM,270,RC,,,outpatient,,,424,212,,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,289.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,375.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,281.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,343.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,390.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,402.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,275.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,381.6,
UHR BIPOLOR 26X45MM,2009571,CDM,270,RC,,,outpatient,,,424,212,,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,289.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,375.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,281.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,343.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,390.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,402.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,275.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,381.6,
UHR BIPOLOR 26X46MM,2009572,CDM,270,RC,,,outpatient,,,1729.25,864.63,,1677.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,1037.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,518.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,1556.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1556.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1037.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1258.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1180.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1037.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1395.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1395.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1532.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1146.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1400.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1590.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,1642.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,1677.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,1124.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,1037.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1037.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1037.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1556.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1037.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1037.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1556.33,
UHR BIPOLOR 26X47MM,2009573,CDM,270,RC,,,outpatient,,,424,212,,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,289.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,375.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,281.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,343.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,390.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,402.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,275.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,381.6,
UHR BIPOLOR 26X48MM,2009574,CDM,278,RC,,,outpatient,,,1679,839.5,,1628.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,1007.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1511.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,1511.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,1007.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1221.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1145.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1007.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1355.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1355.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1487.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1113.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1359.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1544.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,1595.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,1628.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,1091.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,1007.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1007.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1007.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1511.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,1007.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1007.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1511.1,
UHR BIPOLOR 26X49MM,2009575,CDM,270,RC,,,outpatient,,,424,212,,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,289.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,375.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,281.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,343.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,390.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,402.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,275.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,381.6,
UHR BIPOLOR 26X50MM,2009576,CDM,270,RC,,,outpatient,,,424,212,,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,289.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,375.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,281.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,343.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,390.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,402.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,275.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,381.6,
UHR BIPOLOR 26X51MM,2009577,CDM,270,RC,,,outpatient,,,424,212,,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,289.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,375.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,281.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,343.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,390.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,402.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,275.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,381.6,
UHR BIPOLOR 26X52MM,2009578,CDM,270,RC,,,outpatient,,,424,212,,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,289.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,375.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,281.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,343.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,390.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,402.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,275.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,381.6,
UHR BIPOLOR 26X53MM,2009579,CDM,270,RC,,,outpatient,,,424,212,,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,289.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,375.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,281.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,343.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,390.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,402.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,275.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,381.6,
UHR BIPOLOR 26X54MM,2009580,CDM,270,RC,,,outpatient,,,424,212,,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,289.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,375.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,281.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,343.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,390.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,402.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,275.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,381.6,
UHR BIPOLOR 26X55MM,2009581,CDM,270,RC,,,outpatient,,,424,212,,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,289.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,375.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,281.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,343.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,390.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,402.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,275.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,381.6,
UHR BIPOLOR 26X56MM,2009582,CDM,270,RC,,,outpatient,,,424,212,,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,289.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,375.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,281.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,343.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,390.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,402.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,275.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,381.6,
UHR BIPOLOR 26X58MM,2009583,CDM,270,RC,,,outpatient,,,424,212,,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,289.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,375.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,281.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,343.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,390.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,402.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,275.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,381.6,
UHR BIPOLOR 26X61MM,2009584,CDM,270,RC,,,outpatient,,,424,212,,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,289.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,375.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,281.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,343.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,390.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,402.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,275.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,381.6,
UHR BIPOLOR 26X64MM,2009585,CDM,270,RC,,,outpatient,,,424,212,,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,289.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,375.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,281.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,343.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,390.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,402.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,275.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,381.6,
UHR BIPOLOR 26X68MM,2009586,CDM,270,RC,,,outpatient,,,424,212,,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,289.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,342.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,375.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,281.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,343.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,390.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,402.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,411.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,275.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,254.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,381.6,
HII MRI DYMIZATION ROD,2009587,CDM,270,RC,,,outpatient,,,1212,606,,1175.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,727.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,363.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,1090.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1090.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,727.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,881.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,827.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,727.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,978.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,978.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1073.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,803.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,981.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1115.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,1151.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,1175.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,787.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,727.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,727.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,727.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1090.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,727.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,727.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1090.8,
HII MRI COMPRESSION DIST/TUBE,2009588,CDM,270,RC,,,outpatient,,,272,136,,263.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,163.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,244.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,244.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,185.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,163.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,219.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,219.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,241.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,180.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,220.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,250.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,258.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,263.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,176.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,163.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,244.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,163.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,244.8,
HII MRI ROD TO ROD COUPLING 8/8MM,2009589,CDM,270,RC,,,outpatient,,,1946,973,,1887.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,1167.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,583.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,1751.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,1751.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,1167.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1415.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1328.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1167.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1570.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1570.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1724.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1290.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1576.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1790.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,1848.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,1887.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,1264.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,1167.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1167.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1167.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1751.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,1167.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1167.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1751.4,
HII MRI INVERTED PIN TO ROD COUPLING4 5/,2009590,CDM,270,RC,,,outpatient,,,251.25,125.63,,243.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,150.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,226.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,226.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,171.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,150.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,202.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,222.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,166.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,203.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,231.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,238.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,243.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,163.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,150.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,150.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,226.13,
HII MRI ROD TO TUBE COUPLING,2009591,CDM,270,RC,,,outpatient,,,251.25,125.63,,243.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,150.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,226.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,226.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,171.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,150.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,202.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,222.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,166.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,203.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,231.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,238.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,243.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,163.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,150.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,150.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,226.13,
HII MRI 5 HOLE PIN CLAMP,2009592,CDM,270,RC,,,outpatient,,,2063.75,1031.88,,2001.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,1238.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,619.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,1857.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,1857.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,1238.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1501.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1408.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1238.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1665.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1665.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1828.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1368.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1671.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1898.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,1960.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,2001.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,1341.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,1238.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1238.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1238.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1857.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,1238.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1238.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1857.38,
HII MRI 10 HOLE PIN CLAMP,2009593,CDM,270,RC,,,outpatient,,,355.75,177.88,,345.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,320.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,258.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,242.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,213.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,315.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,235.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,288.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,327.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,337.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,345.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,231.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,213.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,213.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,320.18,
HII MRI PELVIC CLAMP,2009594,CDM,270,RC,,,outpatient,,,324,162,,314.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,291.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,291.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,221.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,261.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,261.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,214.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,262.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,298.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,307.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,314.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,210.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,291.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,291.6,
HII MRI STREIGHT POST,2009595,CDM,270,RC,,,outpatient,,,115,57.5,,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,105.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.5,
HII MRI 30T ANGLED POST,2009596,CDM,270,RC,,,outpatient,,,345.5,172.75,,335.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,207.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,310.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,310.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,235.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,207.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,278.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,278.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,306.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,229.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,279.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,317.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,328.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,335.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,224.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,207.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,310.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,207.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,310.95,
HII MRI 90 DEGREE POST,2009597,CDM,270,RC,,,outpatient,,,136.75,68.38,,132.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,123.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,90.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,110.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,125.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,129.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,132.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.08,
APEX CANCELLOUS 70 THR 5X250,2009598,CDM,270,RC,,,outpatient,,,133.75,66.88,,129.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,88.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,108.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,123.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,127.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,129.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,120.38,
APEX S/D HALF PIN 40 THR 5X150,2009599,CDM,270,RC,,,outpatient,,,133.75,66.88,,129.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,88.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,108.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,123.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,127.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,129.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,120.38,
APEX S/D HALF PIN 50 THR 5X200,2009600,CDM,270,RC,,,outpatient,,,133.75,66.88,,129.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,88.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,108.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,123.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,127.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,129.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,120.38,
APEX S/D HALF PIN 50 THR 5X180,2009601,CDM,270,RC,,,outpatient,,,133.75,66.88,,129.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,88.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,108.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,123.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,127.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,129.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,120.38,
APEX S/D HALF PIN 40 C/ THR 5X150,2009602,CDM,270,RC,,,outpatient,,,133.75,66.88,,129.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,88.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,108.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,123.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,127.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,129.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,120.38,
APEX S/D HALF PIN 50 C/ THR 5X200,2009603,CDM,270,RC,,,outpatient,,,133.75,66.88,,129.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,88.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,108.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,123.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,127.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,129.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,120.38,
APEX S/D HALF PIN 30THR 4X120,2009604,CDM,270,RC,,,outpatient,,,108.25,54.13,,105,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,95.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,71.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,87.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,99.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,102.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,105,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,97.43,
MOD HALF PIN  4X120 35 CONT THR,2009605,CDM,270,RC,,,outpatient,,,108.25,54.13,,105,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,95.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,71.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,87.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,99.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,102.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,105,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,97.43,
MOD HALF PIN  4X150 40 CONT THR,2009606,CDM,270,RC,,,outpatient,,,418,209,,405.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,250.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,376.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,376.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,304.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,285.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,250.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,337.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,337.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,370.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,277.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,338.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,384.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,397.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,405.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,271.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,250.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,376.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,250.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,376.2,
MRI SEMI CIRCULAR CURVED ROD 8X174,2009607,CDM,270,RC,,,outpatient,,,129.25,64.63,,125.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,116.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,116.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,88.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,77.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,104.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,85.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,104.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,118.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,122.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,125.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,77.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,77.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,116.33,
MRI CONNECTING ROD 8X65MM,2009608,CDM,270,RC,,,outpatient,,,132,66,,128.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,118.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,90.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,106.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,121.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,125.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,128.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,118.8,
MRI CONNECTING ROD 8X100MM,2009609,CDM,270,RC,,,outpatient,,,132,66,,128.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,118.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,90.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,106.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,121.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,125.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,128.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,118.8,
MRI CONNECTING ROD 8X150MM,2009610,CDM,270,RC,,,outpatient,,,132,66,,128.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,118.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,90.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,106.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,121.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,125.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,128.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,118.8,
MRI CONNECTING ROD 8X200MM,2009611,CDM,270,RC,,,outpatient,,,1049.5,524.75,,1018.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,629.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,314.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,944.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,944.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,629.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,763.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,716.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,629.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,847.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,847.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,929.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,695.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,850.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,965.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,997.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,1018.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,682.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,629.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,629.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,629.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,944.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,629.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,629.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,944.55,
MRI CONNECTING ROD 8X250MM,2009612,CDM,270,RC,,,outpatient,,,135.75,67.88,,131.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,122.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,122.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,92.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,81.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,109.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,90,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,124.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,131.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,81.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,81.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,122.18,
MRI CONNECTING ROD 8X300MM,2009613,CDM,270,RC,,,outpatient,,,139.75,69.88,,135.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,113.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,128.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,135.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,125.78,
MRI CONNECTING ROD 8X350MM,2009614,CDM,270,RC,,,outpatient,,,139.75,69.88,,135.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,113.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,128.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,135.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,125.78,
MRI CONNECTING ROD 8X400MM,2009615,CDM,270,RC,,,outpatient,,,1108.5,554.25,,1075.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,665.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,332.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,997.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,997.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,665.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,806.54,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,756.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,665.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,894.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,894.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,982.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,734.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,897.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1019.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,1053.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,1075.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,720.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,665.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,665.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,665.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,997.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,665.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,665.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,997.65,
MRI CONNECTING ROD 8X450MM,2009616,CDM,270,RC,,,outpatient,,,349,174.5,,338.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,209.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,314.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,314.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,253.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,238.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,209.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,281.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,281.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,309.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,231.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,282.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,321.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,331.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,338.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,226.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,209.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,314.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,209.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,314.1,
MRI CONNECTING ROD 8X500MM,2009617,CDM,270,RC,,,outpatient,,,151.75,75.88,,147.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,136.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,103.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,122.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,100.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,122.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,139.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,144.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,147.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,91.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,136.58,
APEX TRANSFIX 4X250 PIN 5X50THR,2009618,CDM,270,RC,,,outpatient,,,124.5,62.25,,120.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,112.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,84.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,74.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,82.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,100.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,114.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,118.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,120.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,74.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,74.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,112.05,
GRAY PT DRILL 3.2MMX200MM,2009619,CDM,270,RC,,,outpatient,,,91.5,45.75,,88.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,82.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,62.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,60.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,74.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,84.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,86.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,88.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.9,90,
GRAY PT DRILL 4.0 MMX200MM,2009620,CDM,270,RC,,,outpatient,,,355.75,177.88,,345.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,320.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,258.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,242.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,213.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,315.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,235.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,288.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,327.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,337.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,345.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,231.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,213.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,213.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,320.18,
GRAY PT DRILL 4.5 MMX200MM,2009621,CDM,270,RC,,,outpatient,,,92.75,46.38,,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,75.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,88.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,90,
LOCKING SCREW CROSS PIN SELF-T1.7X5MM,2009622,CDM,270,RC,,,outpatient,,,93.5,46.75,,90.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,84.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,75.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,86.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,88.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,90.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,90,
LOCKING SCREW CROSS PIN SELF-T1.7X6MM,2009623,CDM,270,RC,,,outpatient,,,93.5,46.75,,90.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,84.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,75.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,86.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,88.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,90.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,90,
LOCKING SCREW CROSS PIN SELF-T1.7X7MM,2009624,CDM,270,RC,,,outpatient,,,92.75,46.38,,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,75.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,88.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,90,
LOCKING SCREW CROSS PIN SELF-T1.7X8MM,2009625,CDM,270,RC,,,outpatient,,,92.75,46.38,,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,75.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,88.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,90,
LOCKING SCREW CROSS PIN SELF-T1.7X9MM,2009626,CDM,270,RC,,,outpatient,,,92.75,46.38,,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,75.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,88.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,90,
LOCKING SCREW CROSS PIN SELF-T1.7X10MM,2009627,CDM,278,RC,,,outpatient,,,92.75,46.38,,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,75.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,88.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,90,
LOCKING SCREW CROSS PIN SELF-T1.7X11MM,2009628,CDM,278,RC,,,outpatient,,,92.75,46.38,,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,75.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,88.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,90,
LOCKING SCREW CROSS PIN SELF-T1.7X12MM,2009629,CDM,270,RC,,,outpatient,,,93.5,46.75,,90.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,84.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,75.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,86.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,88.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,90.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,90,
LOCKING SCREW CROSS PIN SELF-T1.7X13MM,2009630,CDM,270,RC,,,outpatient,,,92.75,46.38,,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,75.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,88.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,90,
LOCKING SCREW CROSS PIN SELF-T1.7X14MM,2009631,CDM,270,RC,,,outpatient,,,92.75,46.38,,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,75.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,88.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,90,
LOCKING SCREW CROSS PIN SELF-T1.7X15MM,2009632,CDM,270,RC,,,outpatient,,,92.75,46.38,,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,75.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,88.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,90,
LOCKING SCREW CROSS PIN SELF-T1.7X16MM,2009633,CDM,270,RC,,,outpatient,,,92.75,46.38,,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,75.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,88.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,90,
LOCKING SCREW CROSS PIN SELF-T1.7X18MM,2009634,CDM,270,RC,,,outpatient,,,92.75,46.38,,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,75.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,88.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,90,
LOCKING SCREW CROSS PIN SELF-T1.7X20MM,2009635,CDM,270,RC,,,outpatient,,,92.75,46.38,,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,75.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,88.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,90,
LOCKING SCREW CROSS PIN SELF-T1.7X22MM,2009636,CDM,270,RC,,,outpatient,,,92.75,46.38,,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,75.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,88.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,90,
LOCKING SCREW CROSS PIN SELF-T1.7X24MM,2009637,CDM,270,RC,,,outpatient,,,92.75,46.38,,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,75.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,88.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,55.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.65,90,
LOCKING SCREW CROSS PIN SELF-T2.3X6MM,2009638,CDM,270,RC,,,outpatient,,,379.25,189.63,,367.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,341.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,341.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,275.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,258.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,306.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,306.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,336.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,251.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,307.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,348.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,360.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,367.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,246.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,341.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,341.33,
LOCKING SCREW CROSS PIN SELF-T2.3X8MM,2009639,CDM,270,RC,,,outpatient,,,379.25,189.63,,367.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,341.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,341.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,275.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,258.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,306.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,306.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,336.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,251.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,307.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,348.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,360.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,367.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,246.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,341.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,341.33,
LOCKING SCREW CROSS PIN SELF-T2.3X9MM,2009640,CDM,270,RC,,,outpatient,,,379.25,189.63,,367.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,341.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,341.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,275.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,258.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,306.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,306.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,336.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,251.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,307.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,348.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,360.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,367.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,246.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,341.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,341.33,
LOCKING SCREW CROSS PIN SELF-T2.3X10MM,2009641,CDM,270,RC,,,outpatient,,,379.25,189.63,,367.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,341.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,341.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,275.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,258.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,306.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,306.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,336.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,251.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,307.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,348.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,360.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,367.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,246.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,341.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,341.33,
LOCKING SCREW CROSS PIN SELF-T2.3X11MM,2009642,CDM,270,RC,,,outpatient,,,379.25,189.63,,367.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,341.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,341.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,275.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,258.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,306.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,306.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,336.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,251.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,307.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,348.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,360.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,367.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,246.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,341.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,341.33,
LOCKING SCREW CROSS PIN SELF-T2.3X12MM,2009643,CDM,270,RC,,,outpatient,,,379.25,189.63,,367.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,341.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,341.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,275.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,258.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,306.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,306.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,336.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,251.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,307.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,348.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,360.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,367.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,246.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,341.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,341.33,
LOCKING SCREW CROSS PIN SELF-T2.3X13MM,2009644,CDM,270,RC,,,outpatient,,,379.25,189.63,,367.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,341.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,341.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,275.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,258.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,306.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,306.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,336.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,251.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,307.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,348.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,360.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,367.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,246.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,341.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,227.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,341.33,
LOCKING SCREW CROSS PIN SELF-T2.3X14MM,2009645,CDM,270,RC,,,outpatient,,,97,48.5,,94.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,66.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,64.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,78.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,89.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,92.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,94.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.2,90,
LOCKING SCREW CROSS PIN SELF-T2.3X15MM,2009646,CDM,270,RC,,,outpatient,,,97,48.5,,94.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,66.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,64.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,78.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,89.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,92.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,94.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.2,90,
LOCKING SCREW CROSS PIN SELF-T2.3X16MM,2009647,CDM,270,RC,,,outpatient,,,97,48.5,,94.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,66.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,64.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,78.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,89.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,92.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,94.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.2,90,
LOCKING SCREW CROSS PIN SELF-T2.3X18MM,2009648,CDM,270,RC,,,outpatient,,,97,48.5,,94.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,66.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,64.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,78.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,89.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,92.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,94.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.2,90,
LOCKING SCREW CROSS PIN SELF-T2.3X20MM,2009649,CDM,270,RC,,,outpatient,,,97,48.5,,94.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,66.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,64.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,78.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,89.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,92.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,94.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.2,90,
LOCKING SCREW CROSS PIN SELF-T2.3X22MM,2009650,CDM,270,RC,,,outpatient,,,97,48.5,,94.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,66.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,64.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,78.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,89.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,92.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,94.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.2,90,
LOCKING SCREW CROSS PIN SELF-T2.3X24MM,2009651,CDM,270,RC,,,outpatient,,,97,48.5,,94.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,66.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,64.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,78.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,89.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,92.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,94.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.2,90,
LOCKING SCREW CROSS PIN SELF-T2.3X26MM,2009652,CDM,270,RC,,,outpatient,,,97,48.5,,94.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,66.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,64.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,78.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,89.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,92.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,94.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.2,90,
PROFYLE/S PLATE MED STR 4 HOLE,2009653,CDM,270,RC,,,outpatient,,,219.5,109.75,,212.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,197.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,197.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,149.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,177.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,194.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,145.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,177.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,201.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,208.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,212.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,142.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,197.55,
S PROFYLE HAND PLATE WIDE 8H,2009654,CDM,270,RC,,,outpatient,,,233.75,116.88,,226.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,207.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,215.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,222.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.38,
PROFYLE /S PLATE STR 16 HOLE,2009655,CDM,270,RC,,,outpatient,,,176.75,88.38,,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,117.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,143.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,162.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,159.08,
PROFYLE /S PLATE L90DEGR RT 6H,2009656,CDM,270,RC,,,outpatient,,,219.5,109.75,,212.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,197.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,197.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,149.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,177.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,194.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,145.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,177.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,201.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,208.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,212.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,142.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,197.55,
PROFYLE /S PLATE L90DEGR LT 6H,2009657,CDM,270,RC,,,outpatient,,,219.5,109.75,,212.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,197.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,197.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,149.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,177.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,194.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,145.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,177.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,201.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,208.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,212.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,142.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,197.55,
PROFYLE /S PLATE L90DEGR NRW 6 H,2009658,CDM,270,RC,,,outpatient,,,219.5,109.75,,212.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,197.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,197.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,149.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,177.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,194.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,145.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,177.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,201.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,208.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,212.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,142.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,197.55,
PROFYLE /S PLATE REG 7H,2009659,CDM,270,RC,,,outpatient,,,575.25,287.63,,557.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,345.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,517.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,517.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,345.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,418.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,392.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,345.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,464.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,464.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,509.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,381.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,465.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,529.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,546.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,557.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,373.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,345.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,345.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,345.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,517.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,345.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,345.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,517.73,
PROFYLE /T PLATE 90 REG 10H,2009660,CDM,270,RC,,,outpatient,,,126.75,63.38,,122.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,114.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,86.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,84.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,102.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,116.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,120.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,122.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,114.08,
PROFYLE /S PLATEY NRW 7H,2009661,CDM,270,RC,,,outpatient,,,126.75,63.38,,122.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,114.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,86.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,84.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,102.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,116.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,120.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,122.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,114.08,
PROFYLE /S Z PLATE 9 HOLE,2009662,CDM,270,RC,,,outpatient,,,176.75,88.38,,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,117.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,143.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,162.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,159.08,
PROFYLE /S CONDYLAR PLATE BAR 5H RT,2009663,CDM,270,RC,,,outpatient,,,176.75,88.38,,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,117.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,143.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,162.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,159.08,
PROFYLE /S CONDYLAR PLATE BAR 5H LT,2009664,CDM,270,RC,,,outpatient,,,176.75,88.38,,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,117.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,143.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,162.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,159.08,
PROFYLE /S 3D PLATE1 HOLE,2009665,CDM,270,RC,,,outpatient,,,176.75,88.38,,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,117.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,143.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,162.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,159.08,
PROFYLE /S 3D PLATE 2X2 HOLE,2009666,CDM,270,RC,,,outpatient,,,176.75,88.38,,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,117.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,143.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,162.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,159.08,
PROFYLE /S 3D PLATE 3X2 HOLE,2009667,CDM,270,RC,,,outpatient,,,176.75,88.38,,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,117.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,143.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,162.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,159.08,
PROFYLE /S 3D PLATE 4X2 HOLE,2009668,CDM,270,RC,,,outpatient,,,176.75,88.38,,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,117.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,143.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,162.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,159.08,
PROFYLE /S REPLANT PLT 4X2 HOLE,2009669,CDM,270,RC,,,outpatient,,,176.75,88.38,,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,117.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,143.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,162.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,159.08,
PROFYLE /S 3D PLATE 2X2+2,2009670,CDM,270,RC,,,outpatient,,,176.75,88.38,,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,117.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,143.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,162.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,159.08,
PROFYLE /M PLATE STR 4H,2009671,CDM,270,RC,,,outpatient,,,219.5,109.75,,212.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,197.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,197.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,149.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,177.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,194.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,145.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,177.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,201.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,208.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,212.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,142.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,131.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,197.55,
PROFYLE /M PLATE STR med 4H,2009672,CDM,270,RC,,,outpatient,,,219,109.5,,212.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,197.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,197.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,149.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,131.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,176.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,194.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,145.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,177.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,201.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,208.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,212.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,142.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,131.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,131.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,197.1,
PROFYLE /M PLATE STR 16H,2009673,CDM,270,RC,,,outpatient,,,176.75,88.38,,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,117.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,143.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,162.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,159.08,
PROFYLE /M PLATE L-90REG RT 6H,2009674,CDM,270,RC,,,outpatient,,,126.75,63.38,,122.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,114.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,86.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,84.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,102.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,116.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,120.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,122.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,114.08,
PROFYLE /M PLATE L-90REG LT 6H,2009675,CDM,270,RC,,,outpatient,,,126.75,63.38,,122.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,114.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,86.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,84.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,102.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,116.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,120.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,122.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,114.08,
PROFYLE /M PLATE T-90 NRW 6H,2009676,CDM,270,RC,,,outpatient,,,985.75,492.88,,956.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,591.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,295.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,887.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,887.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,591.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,717.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,672.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,591.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,795.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,795.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,873.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,653.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,798.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,906.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,936.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,956.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,640.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,591.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,591.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,591.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,887.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,591.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,591.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,887.18,
PROFYLE /M PLATE T-90 DG REG 7H,2009677,CDM,270,RC,,,outpatient,,,126.75,63.38,,122.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,114.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,86.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,84.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,102.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,116.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,120.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,122.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,114.08,
PROFYLE /M HAND T PLATE WIDE 8H,2009678,CDM,270,RC,,,outpatient,,,233.75,116.88,,226.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,207.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,215.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,222.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.38,
PROFYLE /M  PLATE NRW 7H,2009679,CDM,270,RC,,,outpatient,,,233.75,116.88,,226.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,207.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,215.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,222.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.38,
PROFYLE /M VZ SHAPE 13H,2009680,CDM,270,RC,,,outpatient,,,176.75,88.38,,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,117.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,143.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,162.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,159.08,
PROFYLE /M HAND  ROTATION PLATE 5H,2009681,CDM,270,RC,,,outpatient,,,225.25,112.63,,218.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,202.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,153.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,181.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,199.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,182.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,207.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,213.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,218.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,135.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,202.73,
PROFYLE /M 3D ROTATION PLATE 2X2 HOLE,2009682,CDM,270,RC,,,outpatient,,,126.75,63.38,,122.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,114.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,86.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,84.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,102.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,116.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,120.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,122.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,76.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,114.08,
PROFYLE /M 3D ROTATION PLATE 2X3 HOLE,2009683,CDM,270,RC,,,outpatient,,,176.75,88.38,,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,117.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,143.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,162.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,159.08,
PROFYLE /M 3D ROTATION PLATE 2X4 HOLE,2009684,CDM,270,RC,,,outpatient,,,176.75,88.38,,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,117.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,143.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,162.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,159.08,
PROFYLE /M REPLANT PLATE 4X2 HOLE,2009685,CDM,270,RC,,,outpatient,,,176.75,88.38,,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,117.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,143.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,162.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,159.08,
PROFYLE /M 3D PLATE 2X2+2 HOLE,2009686,CDM,270,RC,,,outpatient,,,176.75,88.38,,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,117.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,143.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,162.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,171.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,106.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,159.08,
PROFYLE / HAND LOCK T PLATE 1.7-STRAI 4,2009687,CDM,270,RC,,,outpatient,,,173,86.5,,167.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,155.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,118.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,153.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,140.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,159.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,164.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,167.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,155.7,
PROFYLE / HAND LOCK T PLATE 1.7-R 10,2009688,CDM,270,RC,,,outpatient,,,233.5,116.75,,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,214.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,221.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.15,
PROFYLE / HAND LOCK T PLATE 1.7-STRAI 1,2009689,CDM,270,RC,,,outpatient,,,233.5,116.75,,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,214.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,221.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.15,
PROFYLE / HAND LOCK L PLATE RT 6H,2009690,CDM,270,RC,,,outpatient,,,173,86.5,,167.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,155.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,118.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,153.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,140.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,159.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,164.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,167.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,155.7,
PROFYLE / HAND LOCK L PLATE LE 6H,2009691,CDM,270,RC,,,outpatient,,,173,86.5,,167.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,155.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,118.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,153.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,140.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,159.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,164.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,167.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,155.7,
PROFYLE / HAND LOCK t PLATE r 6H,2009692,CDM,270,RC,,,outpatient,,,173,86.5,,167.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,155.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,118.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,153.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,140.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,159.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,164.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,167.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,155.7,
PROFYLE / HAND LOCK t PLATE REG 7H,2009693,CDM,270,RC,,,outpatient,,,233.5,116.75,,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,214.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,221.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.15,
PROFYLE / HAND LOCK t PLATE WIDE 8H,2009694,CDM,270,RC,,,outpatient,,,233.5,116.75,,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,214.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,221.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.15,
PROFYLE / HAND LOCK 1.7 z-plate R 9H,2009695,CDM,270,RC,,,outpatient,,,233.5,116.75,,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,214.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,221.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.15,
PROFYLE / HAND LOCK 1.7S ROTATION PLATE,2009696,CDM,270,RC,,,outpatient,,,233.5,116.75,,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,214.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,221.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.15,
PROFYLE 1.7S HAND LOCK 3D PLATE 2X2H,2009697,CDM,270,RC,,,outpatient,,,233.5,116.75,,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,214.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,221.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.15,
PROFYLE 1.7S HAND LOCK 3D PLATE 3X2H,2009698,CDM,270,RC,,,outpatient,,,233.5,116.75,,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,214.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,221.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.15,
PROFYLE 1.7S HAND LOCK 3D PLATE 4X2H,2009699,CDM,270,RC,,,outpatient,,,233.5,116.75,,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,214.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,221.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.15,
PROFYLE 1.7S HAND LOCK 3D REPL PT 4X2H,2009700,CDM,270,RC,,,outpatient,,,233.5,116.75,,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,214.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,221.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.15,
PROFYLE 1.7S HAND LOCK 3D PLATC 2X2+2H,2009701,CDM,270,RC,,,outpatient,,,233.5,116.75,,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,214.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,221.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.15,
PROFYLE M HAND COMP PLATE STRAI BAR 4H,2009702,CDM,270,RC,,,outpatient,,,150.25,75.13,,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135.23,
PROFYLE M HAND COMP PLATE STRAI 6H,2009703,CDM,270,RC,,,outpatient,,,150.25,75.13,,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135.23,
PROFYLE M HAND COMP L  PLATE RI 6H,2009704,CDM,270,RC,,,outpatient,,,150.25,75.13,,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135.23,
PROFYLE M HAND COMP L  PLATE LE 6H,2009705,CDM,270,RC,,,outpatient,,,1215.5,607.75,,1179.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,729.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,364.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,1093.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,1093.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,729.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,884.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,829.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,729.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,981.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,981.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1077.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,805.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,984.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1118.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,1154.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,1179.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,790.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,729.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,729.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,729.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1093.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,729.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,729.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1093.95,
PROFYLE M HAND COMP T PLATE R 6H,2009706,CDM,270,RC,,,outpatient,,,150.25,75.13,,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135.23,
PROFYLE M HAND COMP T PLATE REG 7H,2009707,CDM,270,RC,,,outpatient,,,150.25,75.13,,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135.23,
PROFYLE M HAND COMP Y PLATE R 7H,2009708,CDM,270,RC,,,outpatient,,,150.25,75.13,,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135.23,
PROFYLE M HAND COMP CONDY PLATE RI 6H,2009709,CDM,270,RC,,,outpatient,,,150.25,75.13,,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135.23,
PROFYLE M HAND COMP CONDY PLATE LE 6H,2009710,CDM,270,RC,,,outpatient,,,150.25,75.13,,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135.23,
PROFYLE L HAND ROTATION PLATE 5H,2009711,CDM,270,RC,,,outpatient,,,225.25,112.63,,218.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,202.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,153.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,181.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,199.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,182.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,207.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,213.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,218.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,135.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,202.73,
PROFYLE L HAND COMP  PLATESTRAI BAR 4H,2009712,CDM,270,RC,,,outpatient,,,150.25,75.13,,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135.23,
PROFYLE L HAND COMP  PLATE STRAI BAR 5H,2009713,CDM,270,RC,,,outpatient,,,150.25,75.13,,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135.23,
PROFYLE L HAND COMP  PLATE STRAI BAR 6H,2009714,CDM,270,RC,,,outpatient,,,683.55,341.78,,663.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,410.13,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.07,30,,,percent of total billed charges,Pays at 30% of total billed charges,615.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,615.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,410.13,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,497.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,466.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,410.13,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,551.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,551.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,605.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,453.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,553.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,628.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,649.37,95,,,percent of total billed charges,Pays at 95% of total billed charges,663.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,444.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,410.13,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,410.13,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,410.13,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,615.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,410.13,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,410.13,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,615.2,
PROFYLE L HAND COMP  PLATE STRAI BAR 8H,2009715,CDM,270,RC,,,outpatient,,,150.25,75.13,,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135.23,
PROFYLE L HAND COMP  PLATE RI 6H,2009716,CDM,270,RC,,,outpatient,,,150.25,75.13,,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135.23,
PROFYLE L HAND COMP  PLATE LE 6H,2009717,CDM,270,RC,,,outpatient,,,150.25,75.13,,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135.23,
PROFYLE L HAND COMP T PLATE R 6H,2009718,CDM,270,RC,,,outpatient,,,150.25,75.13,,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135.23,
PROFYLE L HAND COMP T PLATE R 10H,2009719,CDM,270,RC,,,outpatient,,,150.25,75.13,,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135.23,
PROFYLE L HAND COMP T PLATE OBLI RI 6H,2009720,CDM,270,RC,,,outpatient,,,150.25,75.13,,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135.23,
PROFYLE L HAND COMP T PLATE OBLI LE 6H,2009721,CDM,270,RC,,,outpatient,,,150.25,75.13,,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135.23,
PROFYLE L HAND COMP T PLATE  6H,2009722,CDM,270,RC,,,outpatient,,,150.25,75.13,,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135.23,
PROFYLE 2.3 HAND LOCK PLATE STRAI 4H,2009723,CDM,270,RC,,,outpatient,,,173,86.5,,167.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,155.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,118.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,153.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,140.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,159.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,164.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,167.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,155.7,
PROFYLE 2.3 HAND LOCK PLATE STRAIBAR 4H,2009724,CDM,270,RC,,,outpatient,,,173,86.5,,167.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,155.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,118.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,153.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,140.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,159.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,164.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,167.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,155.7,
PROFYLE 2.3 HAND LOCK PLATE STRAI 16H,2009725,CDM,270,RC,,,outpatient,,,233.5,116.75,,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,214.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,221.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.15,
PROFYLE 2.3 HAND LOCK L PLATE RI 6H,2009726,CDM,270,RC,,,outpatient,,,1394.5,697.25,,1352.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,836.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,418.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,1255.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1255.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,836.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1014.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,951.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,836.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1125.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1125.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1235.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,924.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1129.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1282.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,1324.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,1352.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,906.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,836.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,836.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,836.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1255.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,836.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,836.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1255.05,
PROFYLE 2.3 M HAND LOCK L PLATE LE 6H,2009727,CDM,270,RC,,,outpatient,,,173,86.5,,167.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,155.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,118.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,153.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,140.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,159.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,164.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,167.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,155.7,
PROFYLE 2.3 HAND LOCK LE MC PLATE 5H,2009728,CDM,270,RC,,,outpatient,,,233.5,116.75,,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,214.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,221.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.15,
PROFYLE 2.3 HAND LOCK RI MC PLATE 5H,2009729,CDM,270,RC,,,outpatient,,,233.5,116.75,,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,214.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,221.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.15,
PROFYLE 2.3 HAND LOCK T PLATE R 6H,2009730,CDM,270,RC,,,outpatient,,,1399.75,699.88,,1357.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,839.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,419.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,1259.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,1259.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,839.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1018.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,955.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,839.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1129.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1129.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1240.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,928.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1133.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1287.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,1329.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,1357.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,909.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,839.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,839.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,839.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1259.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,839.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,839.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1259.78,
PROFYLE 2.3 HAND LOCKT PLATE REC 7H,2009731,CDM,270,RC,,,outpatient,,,233.5,116.75,,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,214.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,221.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.15,
PROFYLE 2.3 HAND LOCKT PLATEWIDE 8H,2009732,CDM,270,RC,,,outpatient,,,233.5,116.75,,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,214.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,221.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.15,
PROFYLE 2.3 HAND LOCK Y PLATE R 7H,2009733,CDM,270,RC,,,outpatient,,,1889.25,944.63,,1832.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,1133.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,566.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,1700.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1700.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1133.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1374.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1289.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1133.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1525,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1525,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1674.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1252.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1530.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1738.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,1794.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,1832.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,1228.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,1133.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1133.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1133.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1700.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1133.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1133.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1700.33,
PROFYLE 2.3 HAND LOCK Z PLATE R 13H,2009734,CDM,270,RC,,,outpatient,,,233.5,116.75,,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,214.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,221.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.15,
PROFYLE 2.3 HAND LOCKROTATION PLATE 5H,2009735,CDM,270,RC,,,outpatient,,,233.5,116.75,,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,214.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,221.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.15,
PROFYLE 2.3 HAND LOCK 3D PLATE 2X2 H,2009736,CDM,270,RC,,,outpatient,,,233.5,116.75,,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,214.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,221.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.15,
PROFYLE 2.3 HAND LOCK 3D PLATE 3X2 H,2009737,CDM,270,RC,,,outpatient,,,233.5,116.75,,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,214.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,221.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.15,
PROFYLE 2.3 HAND LOCK 3D PLATE 4X2 H,2009738,CDM,270,RC,,,outpatient,,,233.5,116.75,,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,214.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,221.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.15,
PROFYLE 2.3 HAND LOCK 3D REPL PL 4X2 H,2009739,CDM,270,RC,,,outpatient,,,233.5,116.75,,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,214.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,221.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.15,
PROFYLE 2.3 HAND LOCK 3D PLATE,2009740,CDM,270,RC,,,outpatient,,,233.5,116.75,,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,214.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,221.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,140.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.15,
BONE SCREW 1.7X5MM CROSS PIN SELF TAPPIN,2009741,CDM,270,RC,,,outpatient,,,79.5,39.75,,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,
BONE SCREW 1.7X6MM CROSS PIN SELF TAPPIN,2009742,CDM,270,RC,,,outpatient,,,79.5,39.75,,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,
BONE SCREW 1.7X7MM CROSS PIN SELF TAPPIN,2009743,CDM,270,RC,,,outpatient,,,171.75,85.88,,166.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,154.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,154.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,117.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,138.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,113.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,139.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,158.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,163.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,166.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,154.58,
BONE SCREW 1.7X8MM CROSS PIN SELF TAPPIN,2009744,CDM,270,RC,,,outpatient,,,165.75,82.88,,160.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,149.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,109.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,134.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,152.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,157.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,160.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,107.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,149.18,
BONE SCREW 1.7X9MM CROSS PIN SELF TAPPIN,2009745,CDM,270,RC,,,outpatient,,,79.5,39.75,,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,
BONE SCREW 1.7X10MM CROSS PIN SELFTAPPIN,2009746,CDM,270,RC,,,outpatient,,,165.75,82.88,,160.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,149.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,109.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,134.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,152.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,157.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,160.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,107.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,99.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,149.18,
BONE SCREW 1.7X11MM CROSS PIN SELFTAPPIN,2009747,CDM,270,RC,,,outpatient,,,79.5,39.75,,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,
BONE SCREW 1.7X12MM CROSS PIN SELFTAPPIN,2009748,CDM,270,RC,,,outpatient,,,79.5,39.75,,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,
BONE SCREW 1.7X13MM CROSS PIN SELFTAPPIN,2009749,CDM,270,RC,,,outpatient,,,79.5,39.75,,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,
BONE SCREW 1.7X14MM CROSS PIN SELFTAPPIN,2009750,CDM,270,RC,,,outpatient,,,79.5,39.75,,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,
BONE SCREW 1.7X15MM CROSS PIN SELFTAPPIN,2009751,CDM,270,RC,,,outpatient,,,79.5,39.75,,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,
BONE SCREW 1.7X16MM CROSS PIN SELFTAPPIN,2009752,CDM,270,RC,,,outpatient,,,79.5,39.75,,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,
BONE SCREW 1.7X18MM CROSS PIN SELFTAPPIN,2009753,CDM,270,RC,,,outpatient,,,79.5,39.75,,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,
BONE SCREW 1.7X20MM CROSS PIN SELFTAPPIN,2009754,CDM,270,RC,,,outpatient,,,79.5,39.75,,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,
BONE SCREW 1.7X22MM CROSS PIN SELFTAPPIN,2009755,CDM,270,RC,,,outpatient,,,79.5,39.75,,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,
BONE SCREW 1.7X24MM CROSS PIN SELFTAPPIN,2009756,CDM,270,RC,,,outpatient,,,79.5,39.75,,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,
EMERG SCREW 1.9X5MM CROSSPIN SELF T,2009757,CDM,270,RC,,,outpatient,,,79.5,39.75,,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,
EMERG SCREW 1.9X8MM CROSSPIN SELF T,2009758,CDM,270,RC,,,outpatient,,,79.5,39.75,,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,
EMERG SCREW 1.9X10MM CROSSPIN SELF T,2009759,CDM,270,RC,,,outpatient,,,79.5,39.75,,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,
EMERG SCREW 1.9X12MM CROSSPIN SELF T,2009760,CDM,270,RC,,,outpatient,,,79.5,39.75,,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,
BONE SCREW 2.3X6MM CROSSPIN SELF T,2009761,CDM,270,RC,,,outpatient,,,313,156.5,,303.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,281.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,281.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,213.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,252.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,277.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,207.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,253.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,287.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,297.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,303.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,203.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,281.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,281.7,
BONE SCREW 2.3X8MM CROSSPIN SELF T,2009762,CDM,270,RC,,,outpatient,,,166.75,83.38,,161.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,161.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.08,
BONE SCREW 2.3X9MM CROSSPIN SELF T,2009763,CDM,270,RC,,,outpatient,,,313,156.5,,303.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,281.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,281.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,213.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,252.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,277.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,207.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,253.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,287.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,297.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,303.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,203.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,281.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,281.7,
BONE SCREW 2.3X10MM CROSSPIN SELF T,2009764,CDM,270,RC,,,outpatient,,,166.75,83.38,,161.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,161.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.08,
BONE SCREW 2.3X11MM CROSSPIN SELF T,2009765,CDM,270,RC,,,outpatient,,,313,156.5,,303.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,281.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,281.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,213.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,252.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,277.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,207.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,253.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,287.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,297.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,303.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,203.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,281.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,281.7,
BONE SCREW 2.3X12MM CROSSPIN SELF T,2009766,CDM,270,RC,,,outpatient,,,166.75,83.38,,161.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,161.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.08,
BONE SCREW 2.3X13MM CROSSPIN SELF T,2009767,CDM,270,RC,,,outpatient,,,166.75,83.38,,161.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,161.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.08,
BONE SCREW 2.3X14MM CROSSPIN SELF T,2009768,CDM,270,RC,,,outpatient,,,166.75,83.38,,161.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,161.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.08,
BONE SCREW 2.3X15MM CROSSPIN SELF T,2009769,CDM,270,RC,,,outpatient,,,301.75,150.88,,292.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,271.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,271.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,219.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,205.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,267.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,200.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,244.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,277.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,286.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,292.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,196.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,271.58,
SCREW CANNULATED,2009770,CDM,278,RC,,,outpatient,,,919.25,459.63,,891.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,551.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,827.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,827.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,551.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,668.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,627.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,551.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,742.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,742.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,814.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,609.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,744.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,845.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,873.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,891.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,597.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,551.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,551.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,551.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,827.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,551.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,551.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,827.33,
SCREW TI ASNIS 1111,2009771,CDM,270,RC,,,outpatient,,,919.25,459.63,,891.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,551.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,275.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,827.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,827.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,551.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,668.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,627.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,551.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,742.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,742.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,814.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,609.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,744.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,845.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,873.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,891.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,597.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,551.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,551.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,551.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,827.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,551.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,551.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,827.33,
GUIDE ASNIS 1111,2009772,CDM,270,RC,,,outpatient,,,218.5,109.25,,211.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,196.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.98,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,149.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,131.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,176.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,193.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,144.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,176.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,201.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,207.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,211.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,142.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,131.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,131.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,196.65,
SCREW LOCKING 1.7X6MM,2009773,CDM,270,RC,,,outpatient,,,377,188.5,,365.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,339.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,339.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,274.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,257.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,304.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,304.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,334.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,249.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,305.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,346.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,358.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,365.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,245.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,339.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,339.3,
SCREW LOCKING 1.7X7MM,2009774,CDM,270,RC,,,outpatient,,,377,188.5,,365.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,339.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,339.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,274.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,257.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,304.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,304.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,334.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,249.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,305.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,346.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,358.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,365.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,245.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,339.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,339.3,
SCREW LOCKING 1.7X9MM,2009775,CDM,270,RC,,,outpatient,,,377,188.5,,365.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,339.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,339.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,274.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,257.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,304.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,304.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,334.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,249.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,305.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,346.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,358.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,365.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,245.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,339.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,339.3,
SCREW LOCKING 1.7X010MM,2009776,CDM,270,RC,,,outpatient,,,377,188.5,,365.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,339.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,339.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,274.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,257.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,304.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,304.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,334.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,249.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,305.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,346.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,358.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,365.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,245.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,339.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,226.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,339.3,
PROFYLE HAND LOCK T 1.7S,2009777,CDM,270,RC,,,outpatient,,,1889.25,944.63,,1832.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,1133.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,566.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,1700.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1700.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1133.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1374.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1289.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1133.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1525,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1525,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1674.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1252.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1530.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1738.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,1794.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,1832.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,1228.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,1133.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1133.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1133.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1700.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1133.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1133.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1700.33,
BONE 1.7X8MM,2009778,CDM,270,RC,,,outpatient,,,311.25,155.63,,301.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,280.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,280.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,212.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,251.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,275.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,206.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,252.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,286.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,295.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,301.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,202.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,280.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,280.13,
BONE 1.7X11MM,2009779,CDM,270,RC,,,outpatient,,,311.25,155.63,,301.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,280.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,280.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,212.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,251.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,275.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,206.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,252.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,286.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,295.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,301.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,202.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,280.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,280.13,
DRILL BIT TWIST 1.4MM DIA,2009780,CDM,270,RC,,,outpatient,,,372.25,186.13,,361.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,223.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,335.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,335.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,223.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,270.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,254.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,223.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,300.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,300.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,329.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,246.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,301.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,342.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,353.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,361.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,241.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,223.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,335.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,223.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,223.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,335.03,
SCREW TI ASNI III,2009781,CDM,270,RC,,,outpatient,,,954.5,477.25,,925.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,572.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,286.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,859.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,859.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,572.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,694.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,651.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,572.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,770.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,770.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,845.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,632.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,773.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,878.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,906.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,925.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,620.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,572.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,572.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,572.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,859.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,572.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,572.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,859.05,
SCREW TI ASNI III,2009783,CDM,270,RC,,,outpatient,,,945.25,472.63,,916.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,283.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,850.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,850.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,687.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,645.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,763.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,763.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,837.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,626.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,765.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,869.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,897.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,916.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,614.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,850.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,850.73,
GUIDE NON THREADED ASNI III,2009784,CDM,270,RC,,,outpatient,,,175.25,87.63,,169.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,157.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,119.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,116.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,141.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,161.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,166.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,169.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,157.73,
GUIDE CALIBRATED,2009785,CDM,270,RC,,,outpatient,,,218.5,109.25,,211.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,196.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.98,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,149.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,131.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,176.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,193.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,144.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,176.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,201.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,207.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,211.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,142.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,131.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,131.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,196.65,
DISTAL LATERAL PLATE,2009786,CDM,270,RC,,,outpatient,,,2185.75,1092.88,,2120.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,1311.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,655.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,1967.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1967.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1311.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1590.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1491.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1311.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1764.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1764.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1936.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1449.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1770.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2010.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,2076.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,2120.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,1420.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,1311.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1311.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1311.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1967.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1311.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1311.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1967.18,
SCREW TI CANNULATED 4.0X42MM,2009787,CDM,270,RC,,,outpatient,,,618.75,309.38,,600.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,556.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,556.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,450.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,422.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,499.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,499.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,548.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,410.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,501.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,569.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,587.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,600.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,402.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,556.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,556.88,
SCREW LOCKING T10 FULL,2009788,CDM,270,RC,,,outpatient,,,616.75,308.38,,598.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,555.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,555.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,448.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,420.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,497.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,497.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,546.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,408.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,499.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,567.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,585.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,598.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,555.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,555.08,
SCREW LOCKING T10 FULL,2009789,CDM,270,RC,,,outpatient,,,616.75,308.38,,598.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,555.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,555.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,448.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,420.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,497.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,497.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,546.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,408.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,499.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,567.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,585.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,598.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,555.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,555.08,
SCREW LOCKING T10 FULL,2009790,CDM,270,RC,,,outpatient,,,616.75,308.38,,598.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,555.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,555.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,448.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,420.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,497.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,497.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,546.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,408.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,499.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,567.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,585.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,598.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,555.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,555.08,
SCREW LOCKING T10 FULL,2009791,CDM,270,RC,,,outpatient,,,616.75,308.38,,598.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,555.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,555.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,448.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,420.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,497.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,497.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,546.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,408.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,499.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,567.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,585.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,598.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,555.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,370.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,555.08,
BONE SCREW  T10 FULL THREAD,2009792,CDM,270,RC,,,outpatient,,,202,101,,195.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,181.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,181.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.98,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,137.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,163.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,178.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,133.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,163.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,185.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,191.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,195.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,121.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,181.8,
BONE SCREW  T10 FULL THREAD,2009793,CDM,270,RC,,,outpatient,,,336.25,168.13,,326.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,302.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,302.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,244.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,229.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,271.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,297.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,222.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,272.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,309.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,319.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,326.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,218.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,302.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,201.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,302.63,
GUIDE WIRE ASNIS III 1.4X150MM,2009794,CDM,270,RC,,,outpatient,,,274.75,137.38,,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.28,
DRILL BIT AO DIA 2.6MM,2009795,CDM,270,RC,,,outpatient,,,549,274.5,,532.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,494.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,494.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,399.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,374.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,443.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,443.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,486.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,363.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,444.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,505.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,521.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,532.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,356.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,494.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,494.1,
SCREW DRIVER BLADE T10AO,2009796,CDM,270,RC,,,outpatient,,,694.25,347.13,,673.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,416.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,624.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,624.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,416.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,505.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,473.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,416.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,560.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,560.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,615.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,460.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,562.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,638.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,659.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,673.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,451.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,416.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,416.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,416.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,624.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,416.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,416.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,624.83,
STERILE MODIFIED HALL,2009797,CDM,270,RC,,,outpatient,,,626.5,313.25,,607.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,375.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,563.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,563.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,375.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,455.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,427.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,375.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,505.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,505.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,555.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,415.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,507.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,576.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,595.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,607.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,407.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,375.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,375.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,375.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,563.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,375.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,375.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,563.85,
K WIRE 3MMX285MM STERILE,2009798,CDM,272,RC,,,outpatient,,,436.25,218.13,,423.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,261.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,392.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,392.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,261.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,317.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,297.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,261.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,352.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,352.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,386.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,289.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,353.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,401.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,414.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,423.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,283.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,261.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,261.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,261.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,392.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,261.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,261.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,392.63,
GUIDE WIRE .054X6'',2009799,CDM,270,RC,,,outpatient,,,105.25,52.63,,102.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,71.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,69.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,85.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,96.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,99.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,102.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,94.73,
GUIDE WIRE .035X5.75'',2009800,CDM,270,RC,,,outpatient,,,105.25,52.63,,102.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,71.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,69.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,85.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,96.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,99.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,102.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,94.73,
HUMERAL T2 STERILE TEFLON,2009801,CDM,272,RC,,,outpatient,,,842,421,,816.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,505.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,757.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,757.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,505.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,612.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,574.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,505.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,679.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,679.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,746.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,558.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,682.02,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,774.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,799.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,816.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,547.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,505.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,505.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,505.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,757.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,505.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,505.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,757.8,
GUIDE WIRE BALL TIP,2009802,CDM,272,RC,,,outpatient,,,611.5,305.75,,593.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,366.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,550.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,550.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,366.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,444.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,417.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,366.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,493.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,493.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,541.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,405.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,495.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,562.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,580.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,593.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,397.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,366.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,366.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,366.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,550.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,366.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,366.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,550.35,
GUIDE WIRE SMOOTH TIP,2009803,CDM,272,RC,,,outpatient,,,595.25,297.63,,577.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,357.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,535.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,535.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,357.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,433.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,406.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,357.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,480.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,480.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,527.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,394.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,482.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,547.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,565.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,577.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,386.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,357.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,357.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,357.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,535.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,357.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,357.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,535.73,
DRILL BIT 3.5X230MM AO,2009804,CDM,270,RC,,,outpatient,,,618.75,309.38,,600.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,556.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,556.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,450.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,422.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,499.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,499.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,548.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,410.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,501.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,569.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,587.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,600.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,402.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,556.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,556.88,
DRILL BIT 3.5X130MM AO,2009805,CDM,270,RC,,,outpatient,,,618.75,309.38,,600.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,556.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,556.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,450.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,422.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,499.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,499.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,548.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,410.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,501.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,569.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,587.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,600.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,402.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,556.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,556.88,
DRILL BIT 5.0X180MM AO,2009806,CDM,270,RC,,,outpatient,,,618.75,309.38,,600.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,556.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,556.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,450.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,422.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,499.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,499.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,548.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,410.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,501.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,569.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,587.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,600.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,402.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,556.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,371.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,556.88,
HUMERAL T2 STANDARD END,2009807,CDM,270,RC,,,outpatient,,,629.5,314.75,,610.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,377.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,566.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,566.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,377.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,458.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,429.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,377.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,508.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,508.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,557.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,417.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,509.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,579.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,598.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,610.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,409.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,377.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,377.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,377.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,566.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,377.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,377.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,566.55,
HUMERAL T2 IL 7MMX260MM,2009808,CDM,270,RC,,,outpatient,,,5245,2622.5,,5087.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,3147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1573.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,4720.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,4720.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,3147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3816.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3579.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4233.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4233.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4647.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3477.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4248.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4825.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,4982.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,5087.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,3409.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,3147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4720.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,3147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4720.5,
SCREW LOCKING T2 F/T,2009809,CDM,270,RC,,,outpatient,,,667,333.5,,646.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,538.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,538.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,613.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,633.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,646.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,433.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.3,
SCREW LOCKING T2 F/T,2009810,CDM,270,RC,,,outpatient,,,672,336,,651.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,403.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,604.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,604.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,403.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,488.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,458.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,403.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,542.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,542.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,595.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,445.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,544.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,618.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,638.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,651.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,436.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,403.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,403.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,403.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,604.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,403.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,403.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,604.8,
SCREW LOCKING T2 F/T,2009811,CDM,270,RC,,,outpatient,,,667,333.5,,646.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,538.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,538.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,613.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,633.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,646.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,433.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.3,
SCREW LOCKING T2 F/T,2009812,CDM,270,RC,,,outpatient,,,667,333.5,,646.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,538.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,538.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,613.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,633.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,646.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,433.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.3,
HUB CAP /WRIST FUSION PLATE MINI 3,2009813,CDM,278,RC,,,outpatient,,,3291,1645.5,,3192.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,1974.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,987.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,2961.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,2961.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,1974.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2394.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2246.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1974.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2656.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2656.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2916.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2181.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2665.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3027.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,3126.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,3192.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,2139.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,1974.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1974.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1974.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2961.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,1974.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1974.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2961.9,
HUB CAP /WRIST FUSION PLATE POST,2009814,CDM,278,RC,,,outpatient,,,422,211,,409.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,253.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,379.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,379.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,253.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,307.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,288.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,253.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,340.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,340.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,373.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,279.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,341.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,388.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,400.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,409.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,274.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,253.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,253.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,253.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,379.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,253.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,253.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,379.8,
HUB CAP /WRIST FUSION PLATE SCREW CORNER,2009815,CDM,278,RC,,,outpatient,,,395.75,197.88,,383.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,237.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,356.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,356.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,237.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,270.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,237.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,319.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,319.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,350.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,262.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,320.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,364.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,375.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,383.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,257.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,237.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,237.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,237.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,356.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,237.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,237.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,356.18,
MINI WRIST FUSION PLATE REAMER HEAD,2009816,CDM,270,RC,,,outpatient,,,1272.75,636.38,,1234.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,763.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,1145.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,763.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,926.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,868.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,763.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1027.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1027.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1127.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,843.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1030.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1170.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,1209.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,1234.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,827.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,763.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,763.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,763.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,763.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,763.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1145.48,
QUICK RELEASE DRILL,2009817,CDM,270,RC,,,outpatient,,,295.5,147.75,,286.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,177.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,265.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,265.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,177.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,201.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,177.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,238.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,261.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,195.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,239.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,271.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,280.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,286.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,192.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,177.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,265.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,177.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,177.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,265.95,
CRUCIFORM DRIVER TIP,2009818,CDM,270,RC,,,outpatient,,,707.75,353.88,,686.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,636.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,636.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,514.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,483.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,571.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,571.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,627.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,469.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,573.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,651.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,672.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,686.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,460.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,636.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,636.98,
CRUCIFORM SCREW 2.7MMX16.0MM,2009819,CDM,270,RC,,,outpatient,,,143.25,71.63,,138.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,128.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,97.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,94.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,116.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,131.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,136.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,138.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,128.93,
CRUCIFORM SCREW 2.7MMX12.0MM,2009820,CDM,270,RC,,,outpatient,,,143.25,71.63,,138.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,128.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,97.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,94.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,116.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,131.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,136.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,138.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,128.93,
SCREWDRIVER BLADE,2009821,CDM,270,RC,,,outpatient,,,707.75,353.88,,686.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,636.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,636.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,514.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,483.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,571.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,571.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,627.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,469.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,573.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,651.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,672.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,686.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,460.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,636.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,636.98,
BLADE,2009822,CDM,270,RC,,,outpatient,,,707.75,353.88,,686.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,636.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,636.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,514.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,483.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,571.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,571.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,627.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,469.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,573.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,651.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,672.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,686.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,460.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,636.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,636.98,
STEINMAN PIN 2.4,2009823,CDM,270,RC,,,outpatient,,,357.25,178.63,,346.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,214.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,321.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,321.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,214.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,243.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,214.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,288.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,288.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,316.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,236.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,289.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,328.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,339.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,346.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,232.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,214.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,321.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,214.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,214.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,321.53,
STEINMAN PIN 3.5,2009824,CDM,270,RC,,,outpatient,,,413.5,206.75,,401.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,248.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,372.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,372.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,248.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,300.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,282.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,248.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,333.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,333.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,366.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,274.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,334.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,380.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,392.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,401.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,268.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,248.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,248.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,248.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,372.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,248.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,248.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,372.15,
RECIPROCASTING BLADE,2009825,CDM,270,RC,,,outpatient,,,295.5,147.75,,286.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,177.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,265.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,265.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,177.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,201.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,177.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,238.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,261.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,195.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,239.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,271.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,280.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,286.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,192.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,177.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,265.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,177.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,177.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,265.95,
TIGHTROP,2009826,CDM,270,RC,,,outpatient,,,834,417,,808.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,500.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,750.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,750.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,500.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,606.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,569.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,500.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,673.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,673.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,739.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,552.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,675.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,767.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,792.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,808.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,542.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,500.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,500.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,500.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,750.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,500.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,500.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,750.6,
GUIDE WIRE J TIP FIXED CORE,2009827,CDM,272,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,90,
ALLOGRAFT 9.0 OR 9.5,2009828,CDM,278,RC,,,outpatient,,,5540,2770,,5373.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,3324,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2137.58,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4986,90,,,percent of total billed charges,Pays at 90% of total billed charges,4986,90,,,percent of total billed charges,Pays at 90% of total billed charges,3324,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4030.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3781.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3324,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4471.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4471.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4908.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3673.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4487.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5096.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,5263,95,,,percent of total billed charges,Pays at 95% of total billed charges,5373.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,3601,65,,,percent of total billed charges,Pays at 65% of total billed charges,3324,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3324,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3324,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4986,90,,,percent of total billed charges,Pays at 90% of total billed charges,3324,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3324,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4986,
HEWSON SUTURE RETRACTOR,2009829,CDM,272,RC,,,outpatient,,,418.25,209.13,,405.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,376.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,376.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,304.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,285.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,337.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,337.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,370.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,277.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,338.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,384.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,397.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,405.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,271.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,376.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,376.43,
PLATE dr volar smartlock,2009830,CDM,270,RC,,,outpatient,,,3108,1554,,3014.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,1864.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,932.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,2797.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,2797.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,1864.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2261.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2121.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1864.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2508.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2508.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2754,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2060.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2517.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2859.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,2952.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,3014.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,2020.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,1864.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1864.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1864.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2797.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,1864.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1864.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2797.2,
SCREW LOCKING PLATE T10 FULL,2009831,CDM,270,RC,,,outpatient,,,616.5,308.25,,598.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,369.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,554.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,554.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,369.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,448.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,420.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,369.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,497.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,497.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,546.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,408.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,499.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,567.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,585.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,598.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,369.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,369.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,369.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,554.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,369.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,369.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,554.85,
DRILL BIT AO DIA 2.0MM,2009832,CDM,270,RC,,,outpatient,,,329.5,164.75,,319.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,296.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,296.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,239.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,224.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,265.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,265.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,291.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,218.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,266.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,303.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,313.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,319.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,214.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,296.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,197.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,296.55,
BLADE SCREWDRIVER T 8 AO,2009833,CDM,270,RC,,,outpatient,,,692.62,346.31,,671.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,415.57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.79,30,,,percent of total billed charges,Pays at 30% of total billed charges,623.36,90,,,percent of total billed charges,Pays at 90% of total billed charges,623.36,90,,,percent of total billed charges,Pays at 90% of total billed charges,415.57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,503.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,472.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,415.57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,559.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,559.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,613.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,459.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,561.02,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,637.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,657.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,671.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,450.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,415.57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,415.57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,415.57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,623.36,90,,,percent of total billed charges,Pays at 90% of total billed charges,415.57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,415.57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,623.36,
FLIPPCUTTER,2009834,CDM,270,RC,,,outpatient,,,774.5,387.25,,751.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,697.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,697.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,563.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,528.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,625.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,625.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,686.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,513.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,627.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,712.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,735.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,751.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,503.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,697.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,697.05,
TIB ACL,2009835,CDM,270,RC,,,outpatient,,,345.75,172.88,,335.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,207.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,311.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,311.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,235.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,207.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,279.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,279.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,306.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,229.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,280.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,318.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,328.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,335.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,224.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,207.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,311.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,207.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,311.18,
DRILL BIT 4.2X340MM,2009837,CDM,270,RC,,,outpatient,,,632.75,316.38,,613.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,379.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,189.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,569.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,569.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,379.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,460.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,431.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,379.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,510.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,510.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,560.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,419.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,512.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,582.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,601.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,613.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,411.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,379.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,379.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,379.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,569.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,379.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,379.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,569.48,
DRILL BIT 4.2X130MM,2009838,CDM,270,RC,,,outpatient,,,632.75,316.38,,613.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,379.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,189.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,569.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,569.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,379.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,460.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,431.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,379.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,510.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,510.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,560.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,419.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,512.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,582.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,601.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,613.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,411.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,379.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,379.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,379.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,569.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,379.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,379.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,569.48,
IL TIBIAL T2 STD,2009839,CDM,270,RC,,,outpatient,,,5307.5,2653.75,,5148.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,3184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1592.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,4776.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4776.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,3184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3861.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3622.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4284.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4284.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4702.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3518.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4299.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4882.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,5042.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,5148.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,3449.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,3184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4776.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,3184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4776.75,
SCREW LOCKING T2 F/T,2009840,CDM,270,RC,,,outpatient,,,657.75,328.88,,638.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,591.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,591.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,478.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,448.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,530.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,530.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,582.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,436.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,532.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,605.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,624.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,638.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,427.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,591.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,591.98,
SCREW LOCKING T2 F/T,2009841,CDM,270,RC,,,outpatient,,,657.75,328.88,,638.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,591.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,591.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,478.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,448.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,530.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,530.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,582.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,436.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,532.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,605.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,624.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,638.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,427.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,591.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,591.98,
SCREW LOCKING T2 F/T,2009842,CDM,270,RC,,,outpatient,,,657.75,328.88,,638.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,591.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,591.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,478.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,448.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,530.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,530.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,582.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,436.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,532.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,605.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,624.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,638.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,427.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,591.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,591.98,
SCREW LOCKING T2 F/T,2009843,CDM,270,RC,,,outpatient,,,657.75,328.88,,638.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,591.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,591.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,478.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,448.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,530.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,530.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,582.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,436.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,532.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,605.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,624.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,638.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,427.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,591.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,591.98,
SCREW LOCKING T2 F/T,2009844,CDM,270,RC,,,outpatient,,,657.75,328.88,,638.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,591.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,591.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,478.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,448.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,530.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,530.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,582.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,436.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,532.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,605.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,624.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,638.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,427.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,591.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,591.98,
GUIDE WIRE BALL TIP,2009845,CDM,270,RC,,,outpatient,,,667,333.5,,646.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,600.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,538.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,538.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,613.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,633.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,646.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,433.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,400.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.3,
SCREW CANNULATED,2009846,CDM,278,RC,,,outpatient,,,945.25,472.63,,916.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,850.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,850.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,687.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,645.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,763.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,763.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,837.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,626.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,765.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,869.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,897.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,916.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,614.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,850.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,850.73,
SCREW CANNULATED,2009847,CDM,278,RC,,,outpatient,,,945.25,472.63,,916.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,850.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,850.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,687.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,645.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,763.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,763.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,837.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,626.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,765.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,869.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,897.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,916.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,614.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,850.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,567.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,850.73,
GUIDE WIRE THREADED,2009848,CDM,270,RC,,,outpatient,,,175.25,87.63,,169.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,157.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,119.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,116.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,141.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,161.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,166.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,169.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,105.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,157.73,
HEAD RESTRAINT,2009849,CDM,270,RC,,,outpatient,,,95.25,47.63,,92.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,85.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,65.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,63.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,77.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,87.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,90.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,92.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,57.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,57.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.15,90,
CEMENT MIXING SYSTEM,2009850,CDM,272,RC,,,outpatient,,,214,107,,207.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,128.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,192.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,192.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,146.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,128.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,172.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,189.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,141.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,173.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,196.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,203.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,207.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,128.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,128.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,192.6,
BONE SUBSTIUTE,2009851,CDM,272,RC,,,outpatient,,,8082.5,4041.25,,7840.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4849.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2424.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,7274.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7274.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,4849.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5880.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5516.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4849.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6524.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6524.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7161.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5358.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6546.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7435.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,7678.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,7840.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,5253.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,4849.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4849.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4849.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7274.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,4849.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4849.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,7274.25,
ACCUMIX MIXING SYSTEM,2009852,CDM,272,RC,,,outpatient,,,657.75,328.88,,638.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,591.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,591.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,478.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,448.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,530.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,530.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,582.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,436.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,532.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,605.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,624.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,638.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,427.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,591.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,394.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,591.98,
DELIVERY SYSTEM,2009853,CDM,272,RC,,,outpatient,,,1165.25,582.63,,1130.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,699.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,349.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,1048.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1048.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,699.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,847.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,795.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,699.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,940.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,940.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1032.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,772.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,943.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1072.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1106.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,1130.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,757.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,699.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,699.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,699.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1048.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,699.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,699.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1048.73,
DELIVERY SYSTEM,2009854,CDM,272,RC,,,outpatient,,,1165.25,582.63,,1130.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,699.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,349.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,1048.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1048.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,699.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,847.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,795.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,699.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,940.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,940.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1032.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,772.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,943.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1072.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1106.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,1130.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,757.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,699.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,699.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,699.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1048.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,699.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,699.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1048.73,
PLATE FEMUR,2009855,CDM,270,RC,,,outpatient,,,6877,3438.5,,6670.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,4126.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2063.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,6189.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,6189.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4126.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5003.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4693.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4126.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5551.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5551.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6093.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4559.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5570.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6326.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,6533.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,6670.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,4470.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,4126.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4126.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4126.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6189.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4126.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4126.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,6189.3,
SCREW LOCKING  A,2009856,CDM,270,RC,,,outpatient,,,572.25,286.13,,555.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,343.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,515.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,515.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,343.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,416.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,390.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,343.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,461.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,461.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,507.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,379.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,463.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,526.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,543.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,555.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,371.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,343.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,343.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,343.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,515.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,343.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,343.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,515.03,
SCREW LOCKING  B,2009857,CDM,270,RC,,,outpatient,,,572.25,286.13,,555.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,343.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,515.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,515.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,343.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,416.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,390.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,343.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,461.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,461.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,507.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,379.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,463.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,526.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,543.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,555.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,371.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,343.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,343.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,343.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,515.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,343.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,343.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,515.03,
SCREW LOCKING  C,2009858,CDM,270,RC,,,outpatient,,,572.25,286.13,,555.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,343.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,515.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,515.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,343.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,416.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,390.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,343.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,461.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,461.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,507.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,379.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,463.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,526.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,543.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,555.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,371.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,343.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,343.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,343.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,515.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,343.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,343.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,515.03,
SCREW CORTEX A,2009859,CDM,270,RC,,,outpatient,,,127.25,63.63,,123.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,114.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,86.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,84.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,103.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,117.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,120.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,123.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,114.53,
SCREW CORTEX B,2009860,CDM,270,RC,,,outpatient,,,127.25,63.63,,123.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,114.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,86.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,84.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,103.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,117.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,120.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,123.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,114.53,
SCREW CORTEX C,2009861,CDM,270,RC,,,outpatient,,,127.25,63.63,,123.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,114.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,86.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,84.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,103.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,117.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,120.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,123.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,114.53,
DRILL BIT TWIST 4.5/6.5MM,2009862,CDM,270,RC,,,outpatient,,,684.75,342.38,,664.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,410.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,616.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,616.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,410.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,498.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,467.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,410.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,552.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,552.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,606.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,453.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,554.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,629.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,650.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,664.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,445.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,410.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,410.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,410.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,616.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,410.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,410.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,616.28,
CANN COUNTERSINK,2009863,CDM,270,RC,,,outpatient,,,1110,555,,1076.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,666,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,333,30,,,percent of total billed charges,Pays at 30% of total billed charges,999,90,,,percent of total billed charges,Pays at 90% of total billed charges,999,90,,,percent of total billed charges,Pays at 90% of total billed charges,666,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,807.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,757.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,666,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,895.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,895.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,983.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,735.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,899.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1021.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,1054.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,1076.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,721.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,666,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,666,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,666,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,999,90,,,percent of total billed charges,Pays at 90% of total billed charges,666,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,666,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,999,
OVERDRILL  AO DIA 3.5,2009864,CDM,270,RC,,,outpatient,,,549,274.5,,532.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,494.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,494.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,399.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,374.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,443.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,443.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,486.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,363.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,444.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,505.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,521.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,532.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,356.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,494.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,329.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,494.1,
BLADE SCREWDRIVER,2009865,CDM,270,RC,,,outpatient,,,1154.75,577.38,,1120.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,692.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,346.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,1039.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1039.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,692.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,840.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,788.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,692.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,932.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,932.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1023.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,765.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,935.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1062.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,1097.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,1120.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,750.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,692.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,692.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,692.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1039.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,692.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,692.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1039.28,
KWIRE DRILL TIP,2009866,CDM,270,RC,,,outpatient,,,182.5,91.25,,177.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,164.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,124.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,161.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,147.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,167.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,173.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,177.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,164.25,
DRILL BIT NON LOCKING,2009867,CDM,270,RC,,,outpatient,,,893.75,446.88,,866.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,536.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,268.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,804.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,804.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,536.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,650.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,609.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,536.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,721.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,721.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,791.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,592.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,723.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,822.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,849.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,866.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,580.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,536.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,536.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,536.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,804.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,536.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,536.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,804.38,
DRILL BIT  LOCKING SHORT,2009868,CDM,270,RC,,,outpatient,,,881.25,440.63,,854.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,528.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,264.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,793.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,793.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,528.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,641.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,601.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,528.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,711.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,711.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,780.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,584.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,713.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,810.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,837.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,854.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,572.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,528.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,528.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,528.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,793.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,528.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,528.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,793.13,
ALLOGRAFT GRAFT LINK,2009869,CDM,272,RC,,,outpatient,,,5333,2666.5,,5173.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,3199.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1599.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,4799.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,4799.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,3199.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3880.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3639.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3199.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4304.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4304.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4725.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3535.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4319.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4906.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,5066.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,5173.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,3466.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,3199.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3199.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3199.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4799.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,3199.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3199.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4799.7,
SCREW locking 2.3mm a,2009870,CDM,278,RC,,,outpatient,,,416.75,208.38,,404.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,250.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,375.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,375.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,303.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,284.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,250.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,336.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,336.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,369.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,276.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,337.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,383.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,395.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,404.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,270.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,250.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,375.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,250.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,375.08,
SCREW locking 2.3mm B,2009871,CDM,278,RC,,,outpatient,,,416.75,208.38,,404.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,250.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,375.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,375.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,303.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,284.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,250.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,336.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,336.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,369.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,276.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,337.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,383.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,395.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,404.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,270.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,250.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,375.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,250.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,375.08,
SCREWBONE 18MM,2009872,CDM,278,RC,,,outpatient,,,327.5,163.75,,317.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,196.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,294.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,294.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,223.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,196.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,264.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,264.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,290.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,217.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,265.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,301.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,311.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,317.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,212.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,196.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,294.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,196.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,294.75,
SCREWBONE 12MM,2009873,CDM,278,RC,,,outpatient,,,327.5,163.75,,317.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,196.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,294.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,294.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,223.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,196.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,264.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,264.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,290.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,217.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,265.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,301.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,311.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,317.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,212.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,196.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,294.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,196.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,294.75,
TIGHTROPE BTB,2009874,CDM,272,RC,,,outpatient,,,1012.75,506.38,,982.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,607.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,303.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,911.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,911.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,607.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,736.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,691.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,607.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,817.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,817.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,897.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,671.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,820.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,931.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,962.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,982.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,658.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,607.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,607.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,607.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,911.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,607.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,607.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,911.48,
OPEN TIGHTROPE,2009875,CDM,272,RC,,,outpatient,,,341,170.5,,330.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,204.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,306.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,306.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,204.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,248.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,232.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,204.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,275.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,275.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,302.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,226.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,276.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,313.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,323.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,330.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,221.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,204.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,204.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,204.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,306.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,204.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,204.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,306.9,
FLIP CUTTER,2009876,CDM,272,RC,,,outpatient,,,774.5,387.25,,751.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,697.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,697.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,563.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,528.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,625.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,625.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,686.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,513.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,627.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,712.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,735.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,751.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,503.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,697.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,697.05,
FIBERSTICK,2009877,CDM,272,RC,,,outpatient,,,119.25,59.63,,115.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,107.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,81.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,96.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,109.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,113.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,115.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,107.33,
TIGERSTICK,2009878,CDM,272,RC,,,outpatient,,,119.25,59.63,,115.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,107.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,81.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,96.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,109.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,113.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,115.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,107.33,
TIGHTROPE BUTTON,2009879,CDM,272,RC,,,outpatient,,,510,255,,494.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,306,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,153,30,,,percent of total billed charges,Pays at 30% of total billed charges,459,90,,,percent of total billed charges,Pays at 90% of total billed charges,459,90,,,percent of total billed charges,Pays at 90% of total billed charges,306,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,371.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,348.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,306,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,411.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,411.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,451.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,338.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,413.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,469.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,484.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,494.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,331.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,306,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,306,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,306,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,459,90,,,percent of total billed charges,Pays at 90% of total billed charges,306,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,306,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,459,
VITOSS BAZX FOAM PK 5CC,2009880,CDM,272,RC,,,outpatient,,,5752.75,2876.38,,5580.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,3451.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1725.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,5177.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,5177.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,3451.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4185.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3926.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3451.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4643.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4643.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5097.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3814.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4659.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5292.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,5465.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,5580.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,3739.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,3451.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3451.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3451.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5177.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,3451.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3451.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,5177.48,
PROXIMAL LATERAL HUMERUS,2009881,CDM,272,RC,,,outpatient,,,5819,2909.5,,5644.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,3491.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1745.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,5237.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5237.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,3491.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4233.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3971.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3491.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4697.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4697.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5156.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3858,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4713.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5353.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,5528.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,5644.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,3782.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,3491.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3491.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3491.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5237.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,3491.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3491.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,5237.1,
SCREW LOCKING 4.0MM,2009882,CDM,272,RC,,,outpatient,,,541.75,270.88,,525.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,487.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,487.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,394.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,369.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,437.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,437.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,480.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,359.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,438.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,498.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,514.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,525.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,352.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,487.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,487.58,
SCREW LOCKING 4.0MM,2009883,CDM,272,RC,,,outpatient,,,541.75,270.88,,525.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,487.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,487.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,394.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,369.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,437.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,437.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,480.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,359.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,438.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,498.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,514.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,525.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,352.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,487.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,487.58,
SCREW LOCKING 4.0MM,2009884,CDM,272,RC,,,outpatient,,,545,272.5,,528.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,327,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,490.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,490.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,327,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,396.54,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,371.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,327,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,439.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,439.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,482.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,361.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,441.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,501.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,517.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,528.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,354.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,327,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,327,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,327,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,490.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,327,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,327,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,490.5,
SCREW LOCKING 4.0MM,2009885,CDM,272,RC,,,outpatient,,,541.75,270.88,,525.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,487.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,487.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,394.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,369.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,437.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,437.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,480.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,359.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,438.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,498.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,514.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,525.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,352.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,487.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,487.58,
K WIRE WITH DRILL TIP,2009886,CDM,270,RC,,,outpatient,,,182.5,91.25,,177.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,164.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,124.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,161.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,147.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,167.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,173.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,177.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,109.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,164.25,
SCREW LOCKING 4.0MM,2009887,CDM,272,RC,,,outpatient,,,541.75,270.88,,525.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,487.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,487.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,394.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,369.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,437.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,437.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,480.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,359.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,438.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,498.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,514.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,525.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,352.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,487.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,325.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,487.58,
DRILL BIT NON LOCKING SHORT,2009888,CDM,272,RC,,,outpatient,,,888.5,444.25,,861.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,533.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,266.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,799.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,799.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,533.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,646.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,606.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,533.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,717.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,717.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,787.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,589.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,719.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,817.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,844.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,861.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,577.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,533.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,533.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,533.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,799.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,533.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,533.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,799.65,
DRILL BIT  LOCKING SHORT,2009889,CDM,272,RC,,,outpatient,,,874.75,437.38,,848.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,524.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,787.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,787.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,524.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,636.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,597.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,524.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,706.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,706.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,775.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,579.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,708.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,804.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,831.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,848.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,568.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,524.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,524.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,524.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,787.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,524.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,524.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,787.28,
SCREW AIMING BLOCK SET,2009890,CDM,278,RC,,,outpatient,,,470.25,235.13,,456.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,282.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,423.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,423.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,282.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,320.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,282.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,379.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,379.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,416.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,311.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,380.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,432.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,446.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,456.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,305.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,282.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,282.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,282.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,423.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,282.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,282.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,423.23,
AIMING BLOCK PROX. LAT,2009891,CDM,272,RC,,,outpatient,,,2428.5,1214.25,,2355.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,1457.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,728.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,2185.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2185.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,1457.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1766.98,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1657.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1457.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1960.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1960.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2151.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1610.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1967.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2234.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,2307.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,2355.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,1578.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,1457.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1457.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1457.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2185.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,1457.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1457.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2185.65,
OPEN TIGHTROPE ABS,2009892,CDM,272,RC,,,outpatient,,,449,224.5,,435.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,269.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,404.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,404.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,269.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,326.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,306.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,269.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,362.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,362.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,397.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,297.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,363.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,413.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,426.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,435.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,291.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,269.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,404.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,269.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,269.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,404.1,
OPEN TIGHTROPE ABS BUTTON RND 14MM,2009893,CDM,272,RC,,,outpatient,,,534,267,,517.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,320.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,480.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,480.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,388.54,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,364.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,320.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,431.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,431.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,473.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,354.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,432.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,491.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,507.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,517.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,347.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,320.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,480.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,320.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,480.6,
TIGHTROPE ABS IMPLANT BOTTON 4MM,2009894,CDM,278,RC,,,outpatient,,,534,267,,517.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,320.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,480.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,480.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,388.54,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,364.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,320.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,431.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,431.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,473.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,354.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,432.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,491.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,507.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,517.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,347.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,320.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,480.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,320.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,480.6,
OPEN TIGHTROPE ABS IMPLANT,2009895,CDM,278,RC,,,outpatient,,,462.5,231.25,,448.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,277.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,416.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,416.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,277.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,336.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,315.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,277.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,373.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,373.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,409.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,306.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,374.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,425.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,439.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,448.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,300.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,277.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,277.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,277.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,416.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,277.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,277.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,416.25,
TIGHTROPE ACL RT W/TITANIUM,2009896,CDM,272,RC,,,outpatient,,,834,417,,808.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,500.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,750.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,750.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,500.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,606.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,569.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,500.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,673.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,673.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,739.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,552.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,675.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,767.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,792.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,808.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,542.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,500.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,500.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,500.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,750.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,500.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,500.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,750.6,
FLIPCUTTER SHORT 8MM,2009897,CDM,272,RC,,,outpatient,,,774.5,387.25,,751.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,697.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,697.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,563.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,528.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,625.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,625.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,686.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,513.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,627.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,712.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,735.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,751.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,503.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,697.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,697.05,
FLIPCUTTER SHORT 8.5MM,2009898,CDM,272,RC,,,outpatient,,,774.5,387.25,,751.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,697.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,697.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,563.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,528.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,625.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,625.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,686.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,513.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,627.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,712.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,735.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,751.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,503.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,697.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,697.05,
FLIPCUTTER SHORT 9 MM,2009899,CDM,272,RC,,,outpatient,,,774.5,387.25,,751.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,697.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,697.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,563.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,528.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,625.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,625.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,686.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,513.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,627.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,712.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,735.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,751.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,503.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,697.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,697.05,
SAW BLADE 16X5.5X06,2009900,CDM,272,RC,,,outpatient,,,127.25,63.63,,123.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,114.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,86.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,84.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,103.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,117.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,120.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,123.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,114.53,
SUTURE CHROMIC GUT CG-812,2009901,CDM,270,RC,,,outpatient,,,22.75,11.38,,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,90,
SAW BLADE 18.5X10 X 055,2009902,CDM,272,RC,,,outpatient,,,127.25,63.63,,123.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,114.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,86.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,84.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,103.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,117.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,120.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,123.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,114.53,
POUCH DRAIBLE W/CLAMP,2009903,CDM,271,RC,,,outpatient,,,14.75,7.38,,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,90,
TUBING MAIN PUMP,2009905,CDM,272,RC,,,outpatient,,,145.5,72.75,,141.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,130.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,99.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,117.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,96.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,133.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,138.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,141.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.95,
WAND APOLLO -90 ASPIRATING,2009906,CDM,272,RC,,,outpatient,,,453.25,226.63,,439.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,407.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,407.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,329.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,309.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,365.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,365.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,401.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,300.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,367.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,416.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,430.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,439.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,294.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,407.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,407.93,
WAND APOLLO -MP-50,2009907,CDM,272,RC,,,outpatient,,,464.75,232.38,,450.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,278.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,418.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,418.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,278.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,338.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,317.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,278.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,375.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,375.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,411.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,308.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,376.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,427.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,441.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,450.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,302.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,278.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,278.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,278.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,418.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,278.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,278.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,418.28,
WAND APOLLO -90 XL,2009908,CDM,272,RC,,,outpatient,,,453.25,226.63,,439.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,407.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,407.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,329.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,309.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,365.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,365.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,401.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,300.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,367.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,416.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,430.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,439.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,294.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,407.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,407.93,
LASSOW 90DEGREE,2009909,CDM,272,RC,,,outpatient,,,334,167,,323.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,200.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,300.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,300.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,227.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,200.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,269.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,295.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,221.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,270.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,307.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,317.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,323.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,217.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,200.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,300.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,200.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,300.6,
PROBE APOLLO HOOK,2009910,CDM,272,RC,,,outpatient,,,453.25,226.63,,439.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,407.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,407.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,329.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,309.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,365.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,365.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,401.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,300.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,367.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,416.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,430.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,439.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,294.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,407.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,271.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,407.93,
DRILL SHAVER 2.9MM,2009911,CDM,272,RC,,,outpatient,,,226.75,113.38,,219.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,136.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,204.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,204.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.98,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,154.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,136.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,183.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,150.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,183.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,208.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,215.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,219.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,147.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,136.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,204.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,136.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,204.08,
NEEDLE SCORPION,2009912,CDM,272,RC,,,outpatient,,,405.25,202.63,,393.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,243.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,364.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,364.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,243.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,294.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,276.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,243.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,327.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,327.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,359.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,268.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,328.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,372.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,384.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,393.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,263.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,243.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,364.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,243.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,243.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,364.73,
PUSHLOCK 2.9,2009913,CDM,272,RC,,,outpatient,,,953,476.5,,924.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,571.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,285.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,857.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,857.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,571.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,693.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,650.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,571.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,769.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,769.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,844.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,631.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,771.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,876.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,905.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,924.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,619.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,571.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,571.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,571.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,857.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,571.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,571.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,857.7,
NEEDLE W/O FIBERWARE #5,2009914,CDM,272,RC,,,outpatient,,,181.75,90.88,,176.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,163.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,124.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,161.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,147.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,167.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,176.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.58,
PASSPORT 30MM,2009915,CDM,272,RC,,,outpatient,,,153,76.5,,148.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,137.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,104.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,101.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,123.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,140.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,145.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,148.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,137.7,
PASSPORT 40MM,2009916,CDM,272,RC,,,outpatient,,,153,76.5,,148.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,137.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,104.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,101.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,123.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,140.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,145.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,148.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,91.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,137.7,
SHAVER TORPEDO,2009917,CDM,272,RC,,,outpatient,,,240.75,120.38,,233.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,216.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,216.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,175.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,164.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,194.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,213.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,159.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,195.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,221.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,228.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,233.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,156.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,216.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,216.68,
CORKSCREW 4.5,2009918,CDM,272,RC,,,outpatient,,,774.5,387.25,,751.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,697.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,697.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,563.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,528.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,625.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,625.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,686.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,513.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,627.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,712.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,735.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,751.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,503.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,697.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,464.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,697.05,
SHOULDER IMMOBIL  W/ STRAPMED,2009921,CDM,270,RC,,,outpatient,,,19,9.5,,18.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,90,
SHOULDER IMMOBILI LG,2009922,CDM,270,RC,,,outpatient,,,19,9.5,,18.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,90,
IOBAN  DRESSING 213/13'',2009923,CDM,272,RC,,,outpatient,,,18.25,9.13,,17.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,90,
IOBAN  DRESSING 129/100'',2009925,CDM,272,RC,,,outpatient,,,129.5,64.75,,125.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,116.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,116.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,88.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,77.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,104.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,85.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,104.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,119.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,123.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,125.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,77.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,77.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,116.55,
IOBAN  DRESSING 60X90CM,2009926,CDM,272,RC,,,outpatient,,,168,84,,162.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,151.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,151.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,111.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,136.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,154.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,159.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,151.2,
IOBAN  DRESSING 35X60,2009928,CDM,272,RC,,,outpatient,,,61.75,30.88,,59.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,55.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,42.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,40.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,50.02,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,56.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,58.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,59.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,37.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.05,90,
5MM TROCAR,2009934,CDM,272,RC,,,outpatient,,,159.5,79.75,,154.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,143.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,143.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,108.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,95.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,105.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,129.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,146.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,151.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,154.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,95.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,95.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,143.55,
5MM LONG PORT,2009935,CDM,272,RC,,,outpatient,,,291.5,145.75,,282.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,198.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,235.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,258.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,193.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,236.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,268.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,276.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,282.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,189.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,262.35,
LAP CHOLE KIT,2009936,CDM,272,RC,,,outpatient,,,701.25,350.63,,680.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,420.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,631.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,631.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,420.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,510.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,478.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,420.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,566.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,566.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,621.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,464.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,568.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,645.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,666.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,680.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,455.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,420.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,420.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,420.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,631.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,420.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,420.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,631.13,
PROBE HOOK,2009937,CDM,272,RC,,,outpatient,,,400.75,200.38,,388.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,240.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,360.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,360.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,240.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,291.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,273.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,240.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,323.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,323.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,355.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,265.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,324.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,368.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,380.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,388.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,260.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,240.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,240.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,240.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,360.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,240.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,240.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,360.68,
CANNULA 8.25,2009942,CDM,272,RC,,,outpatient,,,119.5,59.75,,115.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,107.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,81.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,96.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,109.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,113.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,115.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,107.55,
PEAK FLOW METER,2009943,CDM,272,RC,,,outpatient,,,130.75,65.38,,126.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,105.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,120.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,124.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117.68,
IOBAN  DRESSING 23X23,2009945,CDM,272,RC,,,outpatient,,,37.5,18.75,,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,34.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,
ESMARK BANDAGE 4'',2009948,CDM,272,RC,,,outpatient,,,18,9,,17.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,90,
KALTOSTAT 5X5 DRESSING,2009949,CDM,272,RC,,,outpatient,,,24.5,12.25,,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,90,
SCREW CORTEX 35MM 202-892,2009950,CDM,270,RC,,,outpatient,,,155,77.5,,150.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,139.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,105.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,137.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,102.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,125.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,142.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,147.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,150.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,139.5,
EPILOCK 4X4 ST,2009951,CDM,271,RC,,,outpatient,,,21.5,10.75,,20.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.9,90,
MITRAFLEX 6x6 ST border dressing,2009952,CDM,271,RC,,,outpatient,,,26.75,13.38,,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,90,
ES EXT 7 SET W VALVES,2009955,CDM,272,RC,,,outpatient,,,33.25,16.63,,32.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,29.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.95,90,
SAL PACK (#400412) 5.5 CM,2009957,CDM,272,RC,,,outpatient,,,49.75,24.88,,48.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,44.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,33.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,32.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,40.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,45.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,47.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,48.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.85,90,
SCREW CORTEX 36MM 202-896,2009959,CDM,270,RC,,,outpatient,,,172.25,86.13,,167.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,117.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,139.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,158.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,163.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,167.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,103.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,155.03,
ASP NEEDLE W/LUER LOCK,2009960,CDM,272,RC,,,outpatient,,,44.75,22.38,,43.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,40.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,41.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,42.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,43.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.85,90,
EASI-LAV 34F,2009965,CDM,271,RC,,,outpatient,,,167.5,83.75,,162.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,111.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,154.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,159.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.75,
EASI-LAV 18F,2009966,CDM,271,RC,,,outpatient,,,169,84.5,,163.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,152.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,115.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,149.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,112.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,136.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,155.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,160.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,163.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,152.1,
ESMARK BANDAGE 6,2009968,CDM,272,RC,,,outpatient,,,15.75,7.88,,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,90,
ESMARK BANDAGE 3'',2009969,CDM,272,RC,,,outpatient,,,41.5,20.75,,40.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,37.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,38.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,39.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,24.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.9,90,
MAMMO NEEDLE 20GA 7.5CM,2009970,CDM,272,RC,,,outpatient,,,147,73.5,,142.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,132.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,100.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,88.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,97.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,119.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,135.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,139.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,142.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,88.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,88.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,132.3,
MAMMO NEEDLE 20GA 8.9CM,2009971,CDM,272,RC,,,outpatient,,,141.25,70.63,,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.13,
SAL PACK  3.5  #400413,2009972,CDM,272,RC,,,outpatient,,,78.25,39.13,,75.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,70.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,53.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,46.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,51.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,63.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,71.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,74.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,75.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,46.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,46.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.95,90,
TUBE FEEDING GASTRO 20FR,2009973,CDM,272,RC,,,outpatient,,,78,39,,75.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,70.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,53.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,46.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,51.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,63.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,71.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,74.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,75.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,46.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,46.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.8,90,
MAMMO NEEDLE 20GA 3.0CM,2009975,CDM,272,RC,,,outpatient,,,131,65.5,,127.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,117.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,106.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,120.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,124.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,127.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,78.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117.9,
VIGILON PRIMARY DRESSING,2009977,CDM,271,RC,,,outpatient,,,11.75,5.88,,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,90,
SUTURE MAXON GS-26,2009981,CDM,270,RC,,,outpatient,,,46.25,23.13,,44.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,41.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,37.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,42.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,27.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.75,90,
SUTURE 0 36IN VICRYL PLUS ANTI VIL CTX,2009982,CDM,270,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,
SUTURE 0 27IN VICRYL PLUS ANTI VIL UR-6,2009983,CDM,270,RC,,,outpatient,,,10,5,,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,30,,,percent of total billed charges,Pays at 30% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,90,
SUTURE 0 27IN VICRYL PL ANTI VIL CT-2,2009985,CDM,270,RC,,,outpatient,,,11,5.5,,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,90,
VAC TUBING STEROTACTIC,2009986,CDM,271,RC,,,outpatient,,,79,39.5,,76.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,53.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,63.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,72.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,76.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.4,90,
VACUUM WOUND CANISTER 500ML,2009987,CDM,271,RC,,,outpatient,,,179.75,89.88,,174.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,161.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,161.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,122.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,145.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,159.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,119.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,145.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,165.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,170.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,174.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,116.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,161.78,
IOBAN 2 IODOPHOR 3M 6650,2009988,CDM,272,RC,,,outpatient,,,42,21,,40.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,37.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.02,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,38.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,39.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.2,90,
IOBAN (IODOPHOR) 3M 6617,2009989,CDM,272,RC,,,outpatient,,,119.75,59.88,,116.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,107.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,81.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,113.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,107.78,
SAGITTAL BLADE 300,2009992,CDM,272,RC,,,outpatient,,,286.25,143.13,,277.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,171.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,257.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,257.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,171.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,195.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,171.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,231.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,231.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,253.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,189.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,231.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,263.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,271.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,277.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,186.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,171.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,257.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,171.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,171.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,257.63,
EZ IO  NEEDLE 25 MM/15GA BLUE,2009993,CDM,272,RC,,,outpatient,,,326,163,,316.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,195.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,293.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,293.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,195.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,237.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,222.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,195.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,263.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,263.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,288.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,216.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,264.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,299.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,309.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,316.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,211.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,195.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,293.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,195.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,195.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,293.4,
MULTI PROBE,2009994,CDM,272,RC,,,outpatient,,,586.5,293.25,,568.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,351.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,175.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,527.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,527.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,351.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,426.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,400.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,351.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,473.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,473.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,519.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,388.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,475.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,539.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,557.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,568.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,381.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,351.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,351.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,351.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,527.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,351.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,351.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,527.85,
PROBE GUIDE,2009995,CDM,272,RC,,,outpatient,,,36.75,18.38,,35.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,33.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,33.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,90,
STAPLER TA-60,2009996,CDM,272,RC,,,outpatient,,,711.25,355.63,,689.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,426.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,640.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,640.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,426.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,517.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,485.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,426.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,574.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,574.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,630.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,471.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,576.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,654.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,675.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,689.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,462.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,426.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,426.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,426.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,640.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,426.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,426.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,640.13,
MICROMARK CLIP,2009999,CDM,272,RC,,,outpatient,,,195.75,97.88,,189.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,176.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,176.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,133.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,158.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,173.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,129.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,158.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,180.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,185.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,189.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,127.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,117.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,176.18,
PENROSE DRAIN 6 X 1/2,2023293,CDM,270,RC,,,outpatient,,,6.5,3.25,,6.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,90,
PENROSE DRAIN 18 X 1/2,2023295,CDM,270,RC,,,outpatient,,,6.75,3.38,,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,90,
SINGULAR POLYPECTOMY SRE,2023297,CDM,272,RC,,,outpatient,,,165.25,82.63,,160.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,148.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,148.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,112.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,99.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,109.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,133.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,152.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,156.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,160.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,107.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,99.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,99.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,148.73,
Allergy shot-1 shot,2569515,CDM,510,RC,,,outpatient,,,35.75,17.88,,34.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.02,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,102.86,
ACETAMINOPHEN (TYLENOL) TAB 325 MG,3000002,CDM,250,RC,,,outpatient,,,1.75,0.88,,1.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,1.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.27,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,1.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,1.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,90,
ACETAMINOPHEN (TYLENOL) SUPP 120 MG,3000006,CDM,250,RC,,,outpatient,,,1.75,0.88,,1.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,1.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.27,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,1.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,1.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,90,
ACETAMINOPHEN (TYLENOL) SUPP 325 MG,3000007,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
ACETAMINOPHEN (TYLENOL) SUPP 650 MG,3000008,CDM,250,RC,,,outpatient,,,1.75,0.88,,1.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,1.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.27,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,1.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,1.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,90,
ACETAMINOPHEN/COD(TYLENOL 3)TAB 300/30MG,3000009,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
ALENDROTE (FOSAMAX) TAB 70MG,3000011,CDM,250,RC,,,outpatient,,,3.25,1.63,,3.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.36,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,90,
ACETAMIN/OXYCODONE(PERCOCET 5) 5MG,3000012,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
ACETYLCYSTEINE (MUCOMYST) PO SOL 6 GM,3000014,CDM,250,RC,,,outpatient,,,23.75,11.88,,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,90,
ACETYLCYSTEINE(ACETADOTE) INJ 1,3000015,CDM,636,RC,,,outpatient,,,239.25,119.63,,232.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,143.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.08,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,215.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,215.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,143.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,163.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,143.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,193.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,212,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,158.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,193.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,220.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,227.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,232.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,143.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,143.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,143.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,215.33,
ALBUMIN 25% INJ 12.5GM/50ML,3000017,CDM,250,RC,,,outpatient,,,153.75,76.88,,149.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.55,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,138.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,138.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,104.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,124.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,101.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,124.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,141.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,146.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,149.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,138.38,
ALCOHOL ISOPROPYL 480 ML,3000019,CDM,270,RC,,,outpatient,,,10,5,,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,30,,,percent of total billed charges,Pays at 30% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,90,
ALLOPURINOL (ZYLOPRIM) TAB 100 MG,3000020,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
ALPRAZOLAM (XAX) TAB 0.5MG,3000022,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
ADVAIR INHALER 100/50,3000023,CDM,250,RC,,,outpatient,,,295.5,147.75,,286.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,177.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,265.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,265.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,177.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,201.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,177.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,238.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,261.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,195.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,239.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,271.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,280.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,286.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,192.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,177.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,265.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,177.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,177.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,265.95,
ADVAIR INHALER 250/50,3000027,CDM,250,RC,,,outpatient,,,287.5,143.75,,278.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,258.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,258.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,196.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,232.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,254.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,190.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,232.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,264.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,273.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,278.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,186.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,258.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,258.75,
ADVAIR INHALER 500/50,3000028,CDM,250,RC,,,outpatient,,,482,241,,467.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,289.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,433.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,433.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,289.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,350.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,328.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,289.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,389.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,389.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,427.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,319.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,390.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,443.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,457.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,467.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,313.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,289.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,289.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,289.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,433.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,289.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,289.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,433.8,
AMINOPHYLLINE INJ 500MG/20ML,3000030,CDM,250,RC,,,outpatient,,,24.25,12.13,,23.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.32,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,90,
AMITRIPTYLINE (ELAVIL) TAB 10 MG,3000031,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
AMITRIPTYLINE (ELAVIL) TAB 25 MG,3000032,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
AMMONIA CAPSULE 0.33 ML,3000034,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
AMOXICILLIN (AMOXIL) CAP 250 MG,3000035,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
AMOXICILLIN (AMOXIL) SUSP 250MG/5ML 80ML,3000037,CDM,250,RC,,,outpatient,,,8,4,,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,90,
AMPICILLIN (OMNIPEN) INJ 250 MG,3000040,CDM,250,RC,,,outpatient,,,21.5,10.75,,20.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.04,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.9,90,
AMOX/CLAV(AUGMENTIN)SUS 200MG/28.5MG/5ML,3000042,CDM,250,RC,,,outpatient,,,14.25,7.13,,13.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,90,
AMPICILLIN (OMNIPEN) INJ 1 GM,3000043,CDM,250,RC,,,outpatient,,,9.25,4.63,,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.04,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,90,
AMPICILLIN (OMNIPEN) INJ 2 GM,3000045,CDM,250,RC,,,outpatient,,,12.75,6.38,,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.04,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,
AMOXICILLIN/CLAVUL(AUGMENTIN)TAB 875MG,3000046,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
ALUMINUM/MAGNESIUM (MAALOX) SUSP 30 ML,3000047,CDM,250,RC,,,outpatient,,,10.75,5.38,,10.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,90,
ALUM/MAG/SIMETHICONE(MYLANTA) SUSP 30ML,3000049,CDM,250,RC,,,outpatient,,,11.25,5.63,,10.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,90,
ARTIFICIAL TEARS(TEARS) 15ML,3000051,CDM,250,RC,,,outpatient,,,9.25,4.63,,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,90,
ASCORBIC ACID (VITAMIN C) TAB 500MG,3000052,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
ASCORBIC ACID (VITAMIN C) INJ 500MG,3000053,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
ASPIRIN CHEWABLE TAB 81 MG,3000054,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
ASPIRIN TAB 325 MG MICRO COATED,3000056,CDM,250,RC,,,outpatient,,,1.75,0.88,,1.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,1.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.27,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,1.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,1.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,90,
ASPRIN ENTERIC(ECOTRIN) TAB 325 MG,3000057,CDM,250,RC,,,outpatient,,,1.75,0.88,,1.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,1.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.27,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,1.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,1.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,90,
ALPHA 1 PROT (ARALAST) INJ 50 ML,3000058,CDM,250,RC,,,outpatient,,,1060.5,530.25,,1028.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,636.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.02,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,954.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,954.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,636.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,771.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,723.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,636.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,856.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,856.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,939.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,703.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,859.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,975.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,1007.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,1028.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,689.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,636.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,636.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,636.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,954.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,636.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,636.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,954.45,
ASPIRIN SUPP 600 MG,3000061,CDM,250,RC,,,outpatient,,,5.25,2.63,,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,90,
ATENOLOL (TENORMIN) TAB 50 MG,3000062,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
ATROPINE INJ 1 ML,3000063,CDM,250,RC,,,outpatient,,,24.75,12.38,,24.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,90,
ATROPINE SYR 10 ML,3000064,CDM,636,RC,,,outpatient,,,32,16,,31.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,28.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,29.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,30.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,31.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.2,90,
BACITRACIN OINT 0.9 GM,3000065,CDM,270,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
BACITRACIN (AK-TRACIN) OINT 28GR,3000066,CDM,250,RC,,,outpatient,,,7,3.5,,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,90,
AZITHROMYCIN(ZITHROMAX)SUSP 200MG/5ML,3000068,CDM,250,RC,,,outpatient,,,41.25,20.63,,40.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.76,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,37.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,39.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,24.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,90,
AZITHROMYCIN (ZITHROMAX) INJ 500 MG,3000069,CDM,250,RC,,,outpatient,,,11.75,5.88,,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.17,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,90,
BENZOCAINE 20% (ORABASE) 12 GM,3000072,CDM,250,RC,,,outpatient,,,17,8.5,,16.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,90,
BEZEPRIL (LOTENSIN) TAB 10 MG,3000073,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
BENZOIN CPD TNC 30 ML,3000075,CDM,250,RC,,,outpatient,,,36,18,,34.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,32.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,33.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.6,90,
BENZTROPINE (COGENTIN) TAB 1 MG,3000076,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
BETAMETHASONE VAL(VALISONE) 0.1% CR 15GM,3000078,CDM,250,RC,,,outpatient,,,56.5,28.25,,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,45.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,51.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,53.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,90,
BISACODYL (DULCOLAX) TAB 5 MG,3000080,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
BISACODYL (DULCOLAX) SUPP 10 MG,3000081,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
SALINE ENEMA (FLEET) 133 ML,3000082,CDM,250,RC,,,outpatient,,,4,2,,3.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,90,
BUMETANIDE (BUMEX) TAB 1 MG,3000089,CDM,250,RC,,,outpatient,,,5,2.5,,4.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,4.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,90,
BUMETANIDE (BUMEX) INJ 1 MG,3000090,CDM,250,RC,,,outpatient,,,9.5,4.75,,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,90,
BUPIVACAINE(SENSORCAINE) 0.5% INJ 30 ML,3000092,CDM,250,RC,,,outpatient,,,5.5,2.75,,5.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,90,
CALAMINE LOTION,3000095,CDM,250,RC,,,outpatient,,,12.75,6.38,,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,
CALCIUM CARB/VIT D(OSCAL D) TAB 250MG,3000098,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
CARBAMAZEPINE(TEGRETOL) TAB 200 MG,3000107,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
CARBAMIDE PEROXIDE 6%(DEBROX) DROPS 15ML,3000109,CDM,250,RC,,,outpatient,,,4,2,,3.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,90,
CARBIDOPA/LEVODOPA(SINEMET)TAB 10/100MG,3000110,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
CARBIDOPA/LEVODOPA(SINEMET)TAB 25/100MG,3000111,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
CEFAZOLIN (KEFZOL) INJ 1 GM,3000122,CDM,250,RC,,,outpatient,,,3.25,1.63,,3.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.8,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.36,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,90,
CEFOXITIN (MEFOXIN) INJ 2 GM,3000131,CDM,250,RC,,,outpatient,,,22.75,11.38,,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,90,
CEFTRIAXONE (ROCEPHIN) INJ 500MG,3000132,CDM,250,RC,,,outpatient,,,3.5,1.75,,3.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,90,
CEFTRIAXONE (ROCEPHIN) INJ 1 GM,3000133,CDM,250,RC,,,outpatient,,,4,2,,3.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,90,
CEFTRIAXONE (ROCEPHIN) INJ 2 GM,3000135,CDM,250,RC,,,outpatient,,,9.5,4.75,,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,90,
CEFUROXIME (CEFTIN) TAB 250 MG,3000136,CDM,250,RC,,,outpatient,,,10.25,5.13,,9.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.15,90,
CEPHALEXIN (KEFLEX) CAP 250 MG,3000144,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
CEPHALEXIN (KEFLEX) SUS 250 MG/5ML,3000149,CDM,250,RC,,,outpatient,,,32.25,16.13,,31.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,29.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,29.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,30.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,31.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.35,90,
CHARCOAL SORBITOL(ACTIDOSE) SUSP 50 GM,3000150,CDM,250,RC,,,outpatient,,,95.75,47.88,,92.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,86.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,65.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,63.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,77.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,88.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,90.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,92.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,57.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,57.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.45,90,
CHARCOAL WATER(ACTIDOSE H20) LIQ 240ML,3000151,CDM,250,RC,,,outpatient,,,72,36,,69.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,64.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,49.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,43.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,58.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,66.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,68.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,43.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,43.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.2,90,
CHOLESTYRAMINE (QUESTRAN) POWDER 4 GM,3000172,CDM,250,RC,,,outpatient,,,8.5,4.25,,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,90,
CITALOPRAM (CELEXA) TAB 10 MG,3000173,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
CLINDAMYCIN (CLEOCIN) IM USE 600 MG,3000181,CDM,250,RC,,,outpatient,,,11.25,5.63,,10.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,90,
CLONIDINE (CATAPRES) TAB 0.1 MG,3000185,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
CLOPIDOGREL (PLAVIX) TAB 75 MG,3000186,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
CLOTRIMAZOLE (LOTRIMIN) CREAM 1% 30 GM,3000188,CDM,250,RC,,,outpatient,,,10.25,5.13,,9.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.15,90,
CLOTRIMAZOLE (GYNE LOTRIMIN) CRM 45GM,3000189,CDM,250,RC,,,outpatient,,,11.5,5.75,,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,90,
COLCHICINE TAB 0.6 MG,3000191,CDM,250,RC,,,outpatient,,,13,6.5,,12.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,90,
CYANOCOBALAMIN (VITAMIN B-12) INJ 1MG,3000195,CDM,250,RC,,,outpatient,,,7.25,3.63,,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,90,
CYCLOBENZAPRINE (FLEXERIL) TAB 5 MG,3000196,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
DANTROLENE (DANTRIUM) INJ  20MG,3000197,CDM,250,RC,,,outpatient,,,173.75,86.88,,168.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,156.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,156.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,118.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,104.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,140.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,153.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,115.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,140.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,159.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,165.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,168.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,104.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,156.38,
DEXAMETHASONE (DECADRON) INJ 10 MG/ML,3000199,CDM,250,RC,,,outpatient,,,6,3,,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.15,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,
DEXTROSE 50% SYRINGE 50 ML,3000202,CDM,250,RC,,,outpatient,,,30.75,15.38,,29.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,27.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.45,90,
ONDANSETRON  (ZOFRAN) INJ 4 MG/2ML,3000204,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
DIAZEPAM (VALIUM) TAB 2 MG,3000213,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
DIAZEPAM (VALIUM) TAB 5 MG,3000214,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
DIAZEPAM (VALIUM) INJ 10 MG,3000215,CDM,250,RC,,,outpatient,,,59,29.5,,57.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,53.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,40.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,47.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,39.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,54.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,56.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,57.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,35.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.4,90,
DICYCLOMINE (BENTYL) CAP 10 MG,3000217,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
DICYCLOMINE (BENTYL) SYRUP 5 ML,3000218,CDM,250,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,
DIGOXIN (LANOXIN) TAB 125 MCG,3000220,CDM,250,RC,,,outpatient,,,3.75,1.88,,3.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,90,
DIGOXIN (LANOXIN) INJ 500 MCG/2ML,3000224,CDM,250,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.64,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,90,
DILTIAZEM (CARDIZEM) TAB 30 MG,3000225,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
DILTIAZEM (CARDIZEM) DRIP 125MG/25ML,3000228,CDM,250,RC,,,outpatient,,,46,23,,44.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,37.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,42.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,90,
DIPHENHYDRAMINE (BEDRYL) CAP 25MG,3000229,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
DIPHENHYDRAMINE (BEDRYL) INJ 50MG/ML,3000231,CDM,250,RC,,,outpatient,,,3.5,1.75,,3.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.94,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,90,
DIPHENOXYLATE/ATROPNE (LOMOTIL) TABLET,3000232,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
"Diphtheria, tetanus acellular, and pertussis vaccine for adults",3000234,CDM,250,RC,,,outpatient,,,135,67.5,,130.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,81,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,121.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,81,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,92.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,81,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,124.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,130.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,81,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,81,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,81,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.5,
TETANUS/DIPH Td(TENIVAC/DECAVAC)INJ0.5ML,3000235,CDM,250,RC,,,outpatient,,,108.25,54.13,,105,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,95.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,71.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,87.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,99.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,102.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,105,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
DOCUSATE SODIUM (COLACE) CAP 100 MG,3000241,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
DOCUSATE SODIUM (COLACE) SYRUP 10 ML,3000242,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
DOXYCYCLINE (VIBRAMYCIN) TAB 100 MG,3000249,CDM,250,RC,,,outpatient,,,5.5,2.75,,5.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,90,
DOXYCYCLINE (VIBRAMYCIN) INJ 100 MG,3000250,CDM,250,RC,,,outpatient,,,71.25,35.63,,69.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,64.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,57.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,65.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,67.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.75,90,
ENOXAPARIN (LOVENOX) INJ 100 MG/1 ML 3ML,3000254,CDM,250,RC,,,outpatient,,,111,55.5,,107.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.86,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,99.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,66.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,75.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,66.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,73.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,89.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,105.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,107.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,66.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,66.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,66.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,99.9,
EPHEDRINE INJ 50 MG/ML 1ML,3000255,CDM,250,RC,,,outpatient,,,23.5,11.75,,22.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,21.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.1,90,
EPINEPHRINE (ADRELIN) INJ 1 MG/1ML,3000259,CDM,250,RC,,,outpatient,,,58.25,29.13,,56.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,52.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,47.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,53.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,55.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,56.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.95,90,
EPINEPHRINE (ADRELIN) SYR 1MG/10ML,3000260,CDM,250,RC,,,outpatient,,,27.25,13.63,,26.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.35,90,
ETOMIDATE (AMIDATE) INJ 20MG/10 ML,3000266,CDM,250,RC,,,outpatient,,,9.75,4.88,,9.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,90,
EZETIMIBE (ZETIA) TAB 10 MG,3000272,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
ETHYL CHLORIDE FINE SPRAY 103.5 ML,3000276,CDM,250,RC,,,outpatient,,,129.25,64.63,,125.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,116.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,116.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,88.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,77.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,104.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,85.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,104.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,118.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,122.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,125.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,77.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,77.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,116.33,
ESCITALOPRAM (LEXAPRO) TAB 10 MG,3000277,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
EMOLLIENT (EUCERIN) LOTION 480 ML,3000278,CDM,250,RC,,,outpatient,,,41,20.5,,39.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,36.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.6,90,
FENTANYL INJ 100MCG/2ML,3000280,CDM,250,RC,,,outpatient,,,6,3,,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,
FERROUS SULFATE(FERGON) TAB 325 MG,3000282,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
IVIG (PRIVIGEN) INJ 10 GM,3000284,CDM,250,RC,,,outpatient,,,1625.75,812.88,,1576.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,975.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1463.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1463.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,975.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1182.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1109.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,975.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1312.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1312.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1440.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1077.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1316.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1495.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,1544.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,1576.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,1056.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,975.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,975.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,975.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1463.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,975.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,975.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1463.18,
FLUORESCEIN STRIP 1 STRIP,3000286,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
FOLIC ACID TAB 1 MG,3000287,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
FOLIC ACID INJ 10 ML,3000288,CDM,250,RC,,,outpatient,,,9.25,4.63,,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,90,
FUROSEMIDE (LASIX) TAB 20 MG,3000290,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
FUROSEMIDE (LASIX) TAB 40 MG,3000291,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
FENOFIBRATE (TRICOR) TAB 145 MG,3000293,CDM,250,RC,,,outpatient,,,6.5,3.25,,6.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,90,
FUROSEMIDE (LASIX) INJ 20MG/2ML 2ML,3000294,CDM,250,RC,,,outpatient,,,4.25,2.13,,4.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,4.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,90,
FUROSEMIDE (LASIX) INJ 40 MG,3000295,CDM,250,RC,,,outpatient,,,5,2.5,,4.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,4.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,90,
GEMFIBROZIL (LOPID) TAB 600 MG,3000296,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
GENTAMICIN (GARAMYCIN) 3MG/ML OPHTH 5 ML,3000298,CDM,250,RC,,,outpatient,,,35.25,17.63,,34.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,31.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.15,90,
FLUTICASONE(FLOSE) SAL 50MCG/SPRAY,3000300,CDM,250,RC,,,outpatient,,,14.25,7.13,,13.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,90,
GENTAMICIN (GARAMYCIN) INJ 20MG/2ML,3000301,CDM,250,RC,,,outpatient,,,5,2.5,,4.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,4.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,90,
GENTAMICIN (GARAMYCIN) INJ 80MG/2ML,3000302,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
GLUCAGON INJ 1MG,3000304,CDM,250,RC,,,outpatient,,,245,122.5,,237.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,220.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,220.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,167.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,197.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,217.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,162.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,198.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,225.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,232.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,237.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,159.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,220.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,147,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,220.5,
GLYBURIDE (DIABETA) TAB 5 MG,3000307,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
GLYCERIN PEDIATRIC SUPP 1 SUPP,3000308,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
GLYCERIN ADULT SUPP 1 SUPP,3000309,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
GLYCOPYRROLATE (ROBINUL) INJ 0.2MG/ML,3000311,CDM,250,RC,,,outpatient,,,7.5,3.75,,7.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,90,
GUAIFENESIN (ROBITUSSIN) SYRUP 100MG/5ML,3000312,CDM,250,RC,,,outpatient,,,6.25,3.13,,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,90,
GUAIFENESIN DM (ROBITUSSIN DM) SYR 120ML,3000314,CDM,250,RC,,,outpatient,,,15.5,7.75,,15.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,90,
HALOPERIDOL (HALDOL) TAB 1MG,3000318,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
HALOPERIDOL (HALDOL) TAB 5MG,3000319,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
HALOPERIDOL (HALDOL) INJ 5MG,3000322,CDM,250,RC,,,outpatient,,,21.75,10.88,,21.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,21.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,90,
"HEPARIN INJ 10,000 UNITS/ML",3000329,CDM,250,RC,,,outpatient,,,7.5,3.75,,7.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,90,
HEPATITIS B (ENGERIX-B)PED INJ 10MCG,3000332,CDM,250,RC,,,outpatient,,,57.5,28.75,,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.9,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,46.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,52.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,54.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,102.86,
HYDRALAZINE (APRESOLINE) TAB 10 MG,3000336,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
HYDRALAZINE (APRESOLINE) TAB 25 MG,3000337,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
HYDRALAZINE (APRESOLINE) INJ 20 MG,3000339,CDM,250,RC,,,outpatient,,,12.75,6.38,,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.38,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,
HYDROCHLOROTHIAZIDE(HCTZ) 25MG,3000340,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
HYDROCORTISONE (HYTONE) 1% CRM 30GM,3000345,CDM,250,RC,,,outpatient,,,6.25,3.13,,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,90,
HYDROCORTISONE (HYTONE) POWDER 25 GM,3000346,CDM,250,RC,,,outpatient,,,168.75,84.38,,163.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,151.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,151.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,115.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,149.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,111.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,136.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,155.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,160.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,163.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,151.88,
HYDROCORTISONE (SOLU CORTEF) INJ 100 MG,3000347,CDM,250,RC,,,outpatient,,,12.25,6.13,,11.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,90,
HYDROGEN PEROXIDE 480 ML,3000352,CDM,250,RC,,,outpatient,,,6,3,,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,
HYDROXYZINE (VISTARIL) CAP 25 MG,3000353,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
IBUPROFEN (MOTRIN) TAB 400 MG,3000357,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
IBUPROFEN (MOTRIN) TAB 600 MG,3000358,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
INSULIN HUMAN R (HUMULIN R) 300UNIT/3 ML,3000368,CDM,250,RC,,,outpatient,,,18.25,9.13,,17.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,90,
KETAMINE INJ 50 MG/1ML 1ML INJ,3000392,CDM,250,RC,,,outpatient,,,17,8.5,,16.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,90,
LATANOPROST (XALATAN) EYE DROPS,3000393,CDM,250,RC,,,outpatient,,,21.75,10.88,,21.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,21.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,90,
LACTULOSE(CHRONULAC) SYRUP 20 GM/30 ML,3000395,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
LEUPROLIDE (LUPRON) INJ 30 MG,3000396,CDM,250,RC,,,outpatient,,,1218.25,609.13,,1181.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,730.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1320,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1096.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,1096.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,730.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,886.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,831.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,730.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,983.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,983.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1079.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,807.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,986.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1120.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,1157.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,1181.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,791.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,730.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,730.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,730.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1096.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,730.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,730.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1096.43,
LEVOTHYROXINE (SYNTHROID) TAB 50 MCG,3000397,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
LEVOTHYROXINE (SYNTHROID) TAB 100 MCG,3000398,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
LIDOCAINE VISCOUS(XYLOCAINE)SYRUP 15 ML,3000399,CDM,250,RC,,,outpatient,,,5,2.5,,4.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,4.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,90,
LIDOCAINE JELLY 2% 5 ML,3000400,CDM,250,RC,,,outpatient,,,25.5,12.75,,24.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.3,90,
LIDOCAINE 2% CARDIAC SYR 100MG/5ML,3000402,CDM,250,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,
LIDOCAINE 1% (XYLOCAINE) INJ 200MG/20ML,3000404,CDM,250,RC,,,outpatient,,,21.75,10.88,,21.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,21.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,90,
LIDOCAINE 2% MDV (XYLOCAINE) INJ 20 ML,3000406,CDM,250,RC,,,outpatient,,,3.75,1.88,,3.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,90,
LIDOCAINE/EPI(XYLOCAINE/EPI) INJ 1%,3000408,CDM,250,RC,,,outpatient,,,6.75,3.38,,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,90,
LIDOCAINE/EPI(XYLOCAINE/EPI) INJ 2% 20ML,3000409,CDM,250,RC,,,outpatient,,,8.5,4.25,,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,90,
LOSARTAN (COZAAR) TAB 50 MG,3000411,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
LORATADINE (CLARITIN) TAB 10 MG,3000415,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
LITHIUM (ESKALITH) TAB 300 MG,3000417,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
LORAZEPAM (ATIVAN) TAB 0.5 MG,3000418,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
MAGNESIUM CITRATE 300 ML,3000421,CDM,250,RC,,,outpatient,,,6.75,3.38,,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,90,
MEGESTROL (MEGACE) SUSP 400MG 10 ML,3000427,CDM,250,RC,,,outpatient,,,8.75,4.38,,8.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,90,
MECLIZINE (ANTIVERT) TAB 25 MG,3000429,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
MEMANTINE (MENDA) TAB 10 MG,3000436,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
MEPERIDINE (DEMEROL) INJ 25 MG,3000438,CDM,250,RC,,,outpatient,,,6.5,3.25,,6.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,90,
MEPERIDINE (DEMEROL) INJ 50 MG,3000439,CDM,250,RC,,,outpatient,,,3.75,1.88,,3.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,90,
METHADONE (DOLOPHINE) TAB 10 MG,3000447,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
METHYLDOPA (ALDOMET) TAB 250 MG,3000454,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
METHYLENE BLUE 0.5% 10 ML,3000456,CDM,250,RC,,,outpatient,,,419,209.5,,406.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,251.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,377.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,377.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,251.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,304.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,285.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,251.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,338.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,338.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,371.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,277.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,339.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,385.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,398.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,406.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,272.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,251.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,377.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,251.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,251.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,377.1,
METHYLPREDNISOLONE(DEPO MEDROL) INJ 40MG,3000457,CDM,250,RC,,,outpatient,,,27.5,13.75,,26.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,90,
METHYLPREDNISOLONE(DEPO MEDROL) INJ 80MG,3000458,CDM,250,RC,,,outpatient,,,46.5,23.25,,45.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,41.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,37.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,42.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,27.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.9,90,
METHYLPREDNISOLONE(SOLU MEDROL)INJ 125MG,3000460,CDM,250,RC,,,outpatient,,,28.25,14.13,,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,90,
METHYLPREDNISOLONE (SOLU MEDROL) INJ 1GM,3000461,CDM,250,RC,,,outpatient,,,121,60.5,,117.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,108.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,98.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,111.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,117.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.9,
METOCLOPRAMIDE (REGLAN) INJ 10 MG,3000463,CDM,250,RC,,,outpatient,,,4,2,,3.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.6,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,90,
METOLAZONE (ZAROXOLYN) TAB 5 MG,3000464,CDM,250,RC,,,outpatient,,,8.25,4.13,,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,90,
METOPROLOL TARTRATE (LOPRESSOR) TAB 25MG,3000466,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
METRONIDAZOLE (FLAGYL) IVPB 500 MG,3000468,CDM,250,RC,,,outpatient,,,29.25,14.63,,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,90,
MICOZOLE VAG CREAM 45 GM,3000470,CDM,250,RC,,,outpatient,,,14,7,,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,90,
MIDAZOLAM (VERSED) INJ 1MG/ML 2ML,3000471,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
MILK OF MAGNESIA SUSPENSION 30 ML,3000473,CDM,250,RC,,,outpatient,,,7,3.5,,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,90,
MINERAL OIL 473 ML,3000475,CDM,250,RC,,,outpatient,,,14.25,7.13,,13.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,90,
MORPHINE INJ 2 MG,3000478,CDM,250,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.57,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,
MORPHINE INJ 4 MG,3000479,CDM,250,RC,,,outpatient,,,9.75,4.88,,9.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.57,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,8.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,90,
MORPHINE INJ 10 MG,3000480,CDM,250,RC,,,outpatient,,,5.25,2.63,,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.57,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,90,
MONTELUKAST (SINGULAIR) TAB 10 MG,3000482,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
LBUPHINE (NUBAIN)  INJ 10 MG,3000486,CDM,250,RC,,,outpatient,,,13.5,6.75,,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,
PEGFILGRASTIM (NEULASTA) INJ 6 MG,3000487,CDM,250,RC,,,outpatient,,,9818.25,4909.13,,9523.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,5890.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4609.86,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,8836.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,8836.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,5890.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7143.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6700.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5890.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7925.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7925.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8699.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6509.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7952.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9032.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,9327.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,9523.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6381.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,5890.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5890.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5890.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8836.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,5890.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5890.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,8836.43,
LOXONE (RCAN) INJ 2MG/2ML,3000488,CDM,250,RC,,,outpatient,,,103,51.5,,99.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,92.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,70.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,61.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,68.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,94.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,97.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,99.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,61.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,61.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,92.7,
NICOTINIC ACID (NIACIN) TAB 500 MG,3000493,CDM,250,RC,,,outpatient,,,4,2,,3.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,90,
NITROFURANTOIN (MACRODANTIN) CAP 50 MG,3000497,CDM,250,RC,,,outpatient,,,9.25,4.63,,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,90,
NITROGLYCERIN (NITROSTAT)SL TAB 0.4MG,3000498,CDM,250,RC,,,outpatient,,,57.5,28.75,,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,46.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,52.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,54.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,55.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,34.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.5,90,
NITROGLYCERIN (NITROBID) OINT 1GM,3000499,CDM,250,RC,,,outpatient,,,8.25,4.13,,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,90,
NITROGLYCERIN PATCH 0.1 MG/HR,3000501,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
NITROGLYCERIN PATCH 0.2 MG/HR,3000502,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
NITROGLYCERIN PATCH 0.4 MG/HR,3000504,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
NITROPRUSSIDE (NIPRIDE) INJ 50 MG,3000508,CDM,250,RC,,,outpatient,,,59.75,29.88,,57.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,53.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,40.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,39.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,48.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,54.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,56.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,57.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,35.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.85,90,
NOREPINEPHRINE (LEVOPHED) INJ 4 MG,3000509,CDM,250,RC,,,outpatient,,,38,19,,36.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,34.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,34.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,36.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,36.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.8,90,
NYSTATIN SUSP 5 ML,3000510,CDM,250,RC,,,outpatient,,,5,2.5,,4.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,4.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,90,
NYSTATIN (MYCOSTATIN) POWDER 15 GM,3000511,CDM,250,RC,,,outpatient,,,18,9,,17.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,90,
NYSTATIN CR 15GM,3000513,CDM,250,RC,,,outpatient,,,13.75,6.88,,13.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.25,90,
NYSTATIN (MYCOSTATIN) OINT 15 GM,3000515,CDM,250,RC,,,outpatient,,,13,6.5,,12.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,90,
NYSTATIN/TRIAMCINOLONE (MYCOLOG)CRM 15GM,3000518,CDM,250,RC,,,outpatient,,,145.75,72.88,,141.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,131.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,99.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,87.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,117.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,129.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,96.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,118.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,134.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,138.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,141.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,87.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,87.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,131.18,
OSELTAMIVIR (TAMIFLU) CAP 75 MG,3000521,CDM,250,RC,,,outpatient,,,10.75,5.38,,10.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,90,
OFLOXACIN OTIC 5 ML,3000522,CDM,250,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,90,
PETROLATUM(TEARS RENEWED) OINT 3.5 GM,3000523,CDM,250,RC,,,outpatient,,,7.25,3.63,,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,90,
SALINE EYE WASH (EYE STREAM) 120 ML,3000524,CDM,250,RC,,,outpatient,,,16.25,8.13,,15.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,90,
OXYMETAZOLINE (AFRIN) 0.05% SAL,3000532,CDM,250,RC,,,outpatient,,,4,2,,3.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,90,
OXYTOCIN (PITOCIN) 10UNIT/1ML 1ML INJ,3000533,CDM,250,RC,,,outpatient,,,5.5,2.75,,5.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.86,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,90,
PANCRELIPASE (PANCREASE) CAPSULE,3000534,CDM,250,RC,,,outpatient,,,6.25,3.13,,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,90,
PANTOPRAZOLE (PROTONIX) TAB 40 MG,3000535,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
PANTOPRAZOLE (PROTONIX) INJ 40 MG,3000536,CDM,250,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,
PENICILLIN VK TAB 250 MG,3000544,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
PHEZOPYRIDINE(PYRIDIUM) TAB 95MG,3000548,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
PHENOBARBITAL (LUMIL) TAB 32.4 MG,3000551,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
BENZOCAINE (CHLORACEPTIC) LOZ 6 MG,3000556,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
PHENYLEPHRINE (NEO-SYNEPH)DRIP10MG/250ML,3000561,CDM,250,RC,,,outpatient,,,5.25,2.63,,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,90,
PHENYTOIN (DILANTIN) CAP 100 MG,3000562,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
PHENYTOIN (DILANTIN) INJ 250 MG,3000565,CDM,250,RC,,,outpatient,,,5.75,2.88,,5.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,90,
PHYSOSTIGMINE (ANTILERIUM) INJ 1 MG,3000566,CDM,250,RC,,,outpatient,,,17,8.5,,16.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,90,
PHYTODIONE ADULT(VITAMIN K)INJ 10MG/ML,3000568,CDM,250,RC,,,outpatient,,,151.5,75.75,,146.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.45,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,136.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,103.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,122.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,100.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,122.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,139.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,143.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,146.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,136.35,
PIOGLITAZONE (ACTOS) TAB 30 MG,3000573,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
POLYETHYLENE GLYCOL(GOLYTELY) 1 GALLON,3000581,CDM,250,RC,,,outpatient,,,30,15,,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9,30,,,percent of total billed charges,Pays at 30% of total billed charges,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,27.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,90,
BAC/NEO/POLY(NEOSPORIN)OPHTH OINT 3.5 GM,3000582,CDM,250,RC,,,outpatient,,,38,19,,36.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,34.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,34.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,36.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,36.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.8,90,
NEO/POLY/GRAM(NEOSPORIN)OPHTH DROPS 10ML,3000583,CDM,250,RC,,,outpatient,,,196,98,,190.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,176.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,176.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.61,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,133.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,117.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,158.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,173.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,129.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,158.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,180.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,186.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,190.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,127.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,117.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,117.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,176.4,
POTASSIUM CHLORIDE (KAON) TAB 10 mEq,3000588,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
POTASSIUM CHLORIDE PWD PKT 20 MEQ,3000589,CDM,250,RC,,,outpatient,,,27.5,13.75,,26.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,90,
POTASSIUM CHLORIDE INJ 40 MEQ,3000590,CDM,250,RC,,,outpatient,,,11.75,5.88,,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.14,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,90,
POTASSIUM PHOSPHATE 3mM P /ML INJ  5 ML,3000595,CDM,250,RC,,,outpatient,,,74.75,37.38,,72.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,49.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,60.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,68.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,72.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,90,
PREDNISONE (DELTASONE) TAB 5 MG,3000605,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
PREDNISONE (DELTASONE) TAB 10 MG,3000607,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
PREDNISONE (DELTASONE) TAB 20 MG,3000609,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
PREGABALIN (LYRICA) CAP 50 MG,3000610,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
PREGABALIN (LYRICA) CAP 75 MG,3000611,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
PROCAIMIDE (PRONESTYL) INJ 1 GM,3000620,CDM,250,RC,,,outpatient,,,84.25,42.13,,81.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,75.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,57.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,50.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,55.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,68.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,77.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,80.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,81.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,50.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,50.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.55,90,
PROCHLORPERAZINE (COMPAZINE) SUP 25 MG,3000627,CDM,250,RC,,,outpatient,,,3.25,1.63,,3.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.36,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,90,
PROMETHAZINE (PHENERGAN) TAB 25 MG,3000629,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
PROMETHAZINE (PHENERGAN) INJ 25 MG,3000634,CDM,250,RC,,,outpatient,,,16,8,,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.6,90,
PROPRANOLOL (INDERAL) TAB 10 MG,3000641,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
PROPRANOLOL (INDERAL) TAB 40 MG,3000643,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
PROPYLTHIOURACIL TAB 50 MG,3000646,CDM,250,RC,,,outpatient,,,5.5,2.75,,5.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,90,
PSYLLIUM (METAMUCIL) POWDER 0.21 OZ,3000649,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
QUETIAPINE (SEROQUEL) TAB 25 MG,3000652,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
RABIES VACCINE (RABAVERT) INJ 1 ML,3000658,CDM,250,RC,,,outpatient,,,617.5,308.75,,598.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,370.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,555.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,555.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,370.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,449.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,421.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,370.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,498.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,498.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,547.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,409.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,500.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,568.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,586.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,598.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,401.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,370.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,555.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,370.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,370.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,555.75,
FAMOTIDINE (PEPCID) 20 MG TAB,3000659,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
ROCURONIUM (ZEMURON) INJ 50MG/5ML,3000669,CDM,250,RC,,,outpatient,,,10.25,5.13,,9.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.15,90,
SILVER SULFADIAZINE (SILVADENE) CR 50 GM,3000671,CDM,250,RC,,,outpatient,,,35.25,17.63,,34.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,31.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.15,90,
SILVER SULFADIAZINE(SILVADENE)CR 400GM,3000672,CDM,250,RC,,,outpatient,,,129.75,64.88,,125.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,116.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,116.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,88.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,77.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,104.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,105.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,119.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,123.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,125.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,77.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,77.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,116.78,
SIMETHICONE(MYLICON)SUSP 80MG/1.2ML 30ML,3000674,CDM,250,RC,,,outpatient,,,5.75,2.88,,5.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,90,
SIMETHICONE (MYLICON) TAB 80 MG,3000676,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
NORMAL SALINE 50 ML MINIBAG,3000682,CDM,258,RC,,,outpatient,,,10.5,5.25,,10.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,90,
NORMAL SALINE 100 ML ADDVANTAGE,3000683,CDM,250,RC,,,outpatient,,,5.25,2.63,,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,90,
NORMAL SALINE VIAL  INJ 10 ML,3000684,CDM,272,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
SODIUM CLORIDE CONC INJ 30 ML,3000685,CDM,250,RC,,,outpatient,,,10,5,,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,30,,,percent of total billed charges,Pays at 30% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,90,
SODIUM POLY SUL(KAYEXALATE)SUSP15GR/60ML,3000686,CDM,250,RC,,,outpatient,,,30.75,15.38,,29.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,27.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.45,90,
SPIRONOLACTONE (ALDACTONE) TAB 25 MG,3000687,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
TAMSULOSIN (FLOMAX) CAP 0.4 MG,3000688,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
SUCCINYLCHOLINE (ANECTINE) INJ 200MG,3000690,CDM,250,RC,,,outpatient,,,43.5,21.75,,42.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.1,90,
SUCRALFATE (CARAFATE) TAB 1 GM,3000691,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
SULFACETAMIDE (BLEPH 10) OPHTH SOL 10 ML,3000692,CDM,250,RC,,,outpatient,,,148.25,74.13,,143.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,133.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,131.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,136.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,140.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,143.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,133.43,
TENECTEPLASE (TNKASE) INJ 50 MG,3000698,CDM,250,RC,,,outpatient,,,12689,6344.5,,12308.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,7613.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,11420.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,11420.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,7613.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9232.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8660.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7613.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10242.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10242.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11243.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8412.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10278.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11673.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,12054.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,12308.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,8247.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,7613.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7613.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7613.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11420.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,7613.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7613.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,11420.1,
TERBUTALINE (BRETHINE) INJ 1 MG,3000701,CDM,250,RC,,,outpatient,,,5.75,2.88,,5.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,90,
TETANUS GLOBULIN(HYPERTET) INJ 250 UNITS,3000703,CDM,250,RC,,,outpatient,,,1021.75,510.88,,991.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,613.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,449.97,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,919.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,919.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,613.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,743.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,697.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,613.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,824.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,824.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,905.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,677.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,827.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,940.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,970.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,991.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,664.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,613.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,613.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,613.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,919.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,613.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,613.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,919.58,
THEOPHYLLINE (THEODUR) TAB 400 MG,3000708,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
THIAMINE (VITAMIN B-1) TAB 100 MG,3000715,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
THIAMINE (VITAMIN B-1) INJ 100 MG,3000716,CDM,250,RC,,,outpatient,,,22.75,11.38,,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,90,
TIMOLOL 0.5% (TIMOPTIC) OPHTH SOL 5 ML,3000729,CDM,250,RC,,,outpatient,,,19,9.5,,18.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.4,90,
TOCOPHEROL (VIT E) CAP 400 UNITS,3000731,CDM,250,RC,,,outpatient,,,2.5,1.25,,2.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.5,90,
TIOTROPIUM (SPIRIVA) INHALER 18 MCG,3000732,CDM,250,RC,,,outpatient,,,158.5,79.25,,153.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,142.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,108.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,95.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,140.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,105.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,128.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,145.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,150.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,153.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,95.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,95.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,142.65,
TRACE ELEMENTS CONC. INJ 1 ML,3000738,CDM,250,RC,,,outpatient,,,27.5,13.75,,26.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,90,
TrazoDONE (DESYREL) TAB 50 MG,3000739,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
TRIAMCINOLONE 0.1% (ARISTOCORT) CR 15 GM,3000741,CDM,250,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,
TRIAMTERENE/HCTZ(DYAZIDE)CAP 37.5/25MG,3000742,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
TRIAMCINOLONE (ARISTOCORT) INJ 40 MG,3000743,CDM,250,RC,,,outpatient,,,14.75,7.38,,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.64,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,90,
SULFAMETHOXAZOLE/TMP (BACTRIM DS) TAB,3000752,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
SULFAMETHOXAZOL/TMP INJ 800MG/160MG/10ML,3000753,CDM,250,RC,,,outpatient,,,35.25,17.63,,34.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,31.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.15,90,
SULFAMETH/TMP (SULFATRIM) SUSP 100ML,3000754,CDM,250,RC,,,outpatient,,,81.25,40.63,,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,55.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,65.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,74.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,77.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,90,
TUBERCULIN SKIN TEST (PPD) 0.1 ML,3000756,CDM,300,RC,,,outpatient,,,27.25,13.63,,26.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.35,102.86,
VANCOMYCIN (VANCOCIN) INJ 500 MG,3000760,CDM,250,RC,,,outpatient,,,8,4,,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,90,
VANCOMYCIN (VANCOCIN) INJ 1 GM,3000761,CDM,250,RC,,,outpatient,,,9.5,4.75,,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,90,
VASOPRESSIN (VASOSTRICT) INJ 20UNITS/ML,3000762,CDM,250,RC,,,outpatient,,,307.5,153.75,,298.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,276.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,276.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,209.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,248.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,272.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,203.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,249.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,282.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,292.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,298.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,199.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,276.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,276.75,
VENLAFAXINE (EFFEXOR XR) CAP 75 MG,3000764,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
VERAPAMIL INJ 5 MG,3000765,CDM,250,RC,,,outpatient,,,107.75,53.88,,104.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,96.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,95.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,71.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,87.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,99.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,102.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,104.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,64.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,96.98,
MULTIVITAMIN (THERAGRAN M) TAB,3000767,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
MULTIVITAMIN (THERAGRAN) LIQUID 240 ML,3000768,CDM,250,RC,,,outpatient,,,32.75,16.38,,31.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,31.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,90,
MULTIVITAMIN INJ 10 ML,3000770,CDM,250,RC,,,outpatient,,,29.5,14.75,,28.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,26.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,27.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.7,90,
WARFARIN (COUMADIN) TAB 2 MG,3000772,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
WARFARIN (COUMADIN) TAB 2.5 MG,3000773,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
WARFARIN (COUMADIN) TAB 5 MG,3000774,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
WATER INJECTION 10 ML,3000779,CDM,250,RC,,,outpatient,,,11.25,5.63,,10.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,90,
WITCH HAZEL PADS 100 EACH,3000783,CDM,250,RC,,,outpatient,,,25.25,12.63,,24.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.15,90,
ZINC SULFATE TABLET 220 MG,3000784,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
ZINC OXIDE (DESITIN) PASTE 30 GM,3000785,CDM,250,RC,,,outpatient,,,21.5,10.75,,20.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.9,90,
ELAPRIL (VASOTEC) TAB 5 MG,3000815,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
HYDROXYZINE (ATARAX) TAB 10 MG,3000823,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
LABETALOL (NORMODYNE) INJ 100 MG,3000824,CDM,250,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,
KETOROLAC (TORADOL) INJ 60MG/2ML,3000826,CDM,250,RC,,,outpatient,,,6,3,,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.52,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,
LISINOPRIL (PRINIVIL) TAB 10 MG,3000828,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
MAGNESIUM SULFATE 50% (1GM / 2 ML) INJ,3000832,CDM,250,RC,,,outpatient,,,17,8.5,,16.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.2,90,
MORPHINE PCA INJ 30 MG,3000835,CDM,250,RC,,,outpatient,,,31.5,15.75,,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.57,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,
MUPIROCIN (BACTROBAN) OINTMENT 22 GM,3000836,CDM,250,RC,,,outpatient,,,21.25,10.63,,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,90,
NIFEDIPINE XL (PROCARDIA XL) TAB 30MG,3000837,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
OMALIZUMAB (XOLAIR) INJ 150 MG,3000841,CDM,250,RC,,,outpatient,,,2182,1091,,2116.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,1309.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.25,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1963.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1963.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1309.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1587.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1489.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1309.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1761.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1761.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1933.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1446.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1767.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2007.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,2072.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,2116.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,1418.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,1309.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1309.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1309.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1963.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1309.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1309.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1963.8,
PROPOFOL (DIPRIVAN) INJ 20MG/ML 10ML,3000843,CDM,250,RC,,,outpatient,,,9.5,4.75,,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,90,
PROMETHAZINE (PHENERGAN) SUPP 25 MG,3000846,CDM,250,RC,,,outpatient,,,27.5,13.75,,26.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,90,
SODIUM BICARBOTE INJ 50 MEQ 50ML,3000849,CDM,250,RC,,,outpatient,,,29.25,14.63,,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,90,
DILTIAZEM (CARDIZEM CD) CAP 180 MG,3000852,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
VERAPAMIL (CALAN SR) TAB 240 MG,3000856,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
TOBRAMYCIN/DEX(TOBRADEX)OPHTH SUSP 5 ML,3000857,CDM,250,RC,,,outpatient,,,158.5,79.25,,153.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,142.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,108.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,95.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,140.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,105.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,128.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,145.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,150.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,153.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,95.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,95.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,142.65,
CEFTAZIDIME (TAZICEF) INJ 1 GM,3000867,CDM,250,RC,,,outpatient,,,15.25,7.63,,14.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.08,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,13.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.15,90,
FLUOXETINE (PROZAC) CAP 20 MG,3000879,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
METOPROLOL (LOPRESSOR) INJ 5 MG,3000892,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
MISOPROSTOL (CYTOTEC) TAB 100 MCG,3000893,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
MORPHINE PF INJ (DURAMORPH) 5MG/10ML,3000911,CDM,250,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,90,
ADENOSINE INJ 6 MG,3000915,CDM,250,RC,,,outpatient,,,6,3,,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,
ACYCLOVIR (ZOVIRAX) CAP 200 MG,3000918,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
BENZOTATE(TESSALON PERLE) CAP 100 MG,3000921,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
CALCIUM CARBOTE (TUMS) TAB 500 MG,3000923,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
BUSPIRONE (BUSPAR) TAB 10 MG,3000924,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
PROCHLORPERAZINE (COMPAZINE) TAB 5 MG,3000939,CDM,250,RC,,,outpatient,,,3.5,1.75,,3.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,90,
SIMVASTATIN (ZOCOR) TAB 10 MG,3000940,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
SIMVASTATIN (ZOCOR) TAB 40 MG,3000941,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
BENZOCAINE (AMERICAINE) 20% SPRAY 60ML,3000950,CDM,250,RC,,,outpatient,,,16.5,8.25,,16.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,90,
CLONIDINE(CATAPRES)TTS-1 PATCH 0.1MG/24H,3000954,CDM,250,RC,,,outpatient,,,59,29.5,,57.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,53.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,40.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,47.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,39.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,54.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,56.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,57.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,35.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.4,90,
CLONIDINE(CATAPRES)TTS-3 PATCH 0.3MG/24H,3000955,CDM,250,RC,,,outpatient,,,168.75,84.38,,163.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,151.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,151.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,115.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,149.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,111.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,136.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,155.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,160.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,163.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,101.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,151.88,
IODINE/POVIDONE 10%(BETADINE) SOLN 118ML,3000956,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
TOLFTATE 1% (TICTIN) CREAM 15 GM,3000964,CDM,250,RC,,,outpatient,,,6,3,,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,
ZINC OXIDE (DESITIN) PASTE 454 GM,3000965,CDM,250,RC,,,outpatient,,,18.5,9.25,,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,90,
PREDNISOLONE(PRED FORTE)OPHTH SUSP 5ML,3000974,CDM,250,RC,,,outpatient,,,139.5,69.75,,135.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,113,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,128.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,135.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,125.55,
GENTAMICIN (GARAMYCIN) OPHTH OINT 3.5 GM,3000989,CDM,250,RC,,,outpatient,,,42.75,21.38,,41.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,39.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,90,
NEO/POLY/HC (CORTISPORIN) OTIC 10ML,3001004,CDM,250,RC,,,outpatient,,,159,79.5,,154.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,143.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,143.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,108.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,95.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,140.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,105.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,128.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,146.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,151.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,154.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,95.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,95.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,143.1,
ALBUTEROL(PROVENTIL) NEBULIZER 2.5MG/3ML,3001006,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
EPINEPHRINE RACEMIC INH 0.5 ML,3001009,CDM,250,RC,,,outpatient,,,6.75,3.38,,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,90,
BUPIVACAINE SP(SENSORCAINE)0.75% AMP2ML,3001013,CDM,250,RC,,,outpatient,,,14.25,7.13,,13.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,90,
DEXTROSE 25% INJ 10 ML,3001021,CDM,250,RC,,,outpatient,,,27.75,13.88,,26.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,90,
DIGOXIN IMMUNE FAB(DIGIBIND) INJ 40MG,3001022,CDM,250,RC,,,outpatient,,,8517.5,4258.75,,8261.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,5110.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3931.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,7665.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,7665.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,5110.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6197.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5813.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5110.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6875.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6875.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7547.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5647.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6899.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7836.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,8091.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,8261.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,5536.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,5110.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5110.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5110.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7665.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,5110.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5110.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,7665.75,
HEPARIN FLUSH(HEP LOCK)10 UNIT/ML 3 ML,3001028,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
LEVOTHYROXINE (SYNTHROID) INJ 100 MCG,3001031,CDM,250,RC,,,outpatient,,,215,107.5,,208.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,129,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,193.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,193.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,129,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,146.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,129,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,173.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,190.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,142.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,174.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,197.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,204.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,208.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,129,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,129,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,129,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,193.5,
NEOSTIGMINE (PROSTIGMINE) INJ 10 ML,3001036,CDM,250,RC,,,outpatient,,,22.25,11.13,,21.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.77,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,20.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.02,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,21.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.35,90,
NITROGLYCERIN (TRIDIL)200MCG/ML 250 ML,3001037,CDM,259,RC,,,outpatient,,,32,16,,31.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,28.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,29.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,30.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,31.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.2,90,
PENICILLIN G(BICILLIN LA)600000 UNIT/ML,3001039,CDM,250,RC,,,outpatient,,,175,87.5,,169.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,105,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,157.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,105,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,119.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,116.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,141.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,161,92,,,percent of total billed charges,Pays at 92% of total billed charges,166.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,169.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,105,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,105,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,105,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,157.5,
SODIUM BICARBOTE INJ 5 mEq 10ML,3001040,CDM,250,RC,,,outpatient,,,32.5,16.25,,31.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,29.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,29.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,30.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,31.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.5,90,
VECURONIUM (NORCURON) INJ 10 MG,3001043,CDM,250,RC,,,outpatient,,,15.25,7.63,,14.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.15,90,
PHENOBARBITAL INJ 65 MG,3001047,CDM,250,RC,,,outpatient,,,57,28.5,,55.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,51.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,34.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,46.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,52.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,54.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,55.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,34.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,34.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.2,90,
DIVALPROEX (DEPAKOTE)SPRINKLE CAP 125 MG,3001057,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
DIVALPROEX (DEPAKOTE) SODIUM DR 250 MG,3001058,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
NICOTINE (NICOTROL) PATCH 21 MG/24HR,3001060,CDM,250,RC,,,outpatient,,,6,3,,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,
NICOTINE (NICOTROL) PATCH 14 MG/24HR,3001061,CDM,250,RC,,,outpatient,,,3.75,1.88,,3.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,90,
NICOTINE (NICOTROL) PATCH 7 MG/24HR,3001062,CDM,250,RC,,,outpatient,,,7,3.5,,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,90,
LISINOPRIL (PRINIVIL) TAB 5 MG,3001068,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
pneumococcal Pneumococcal vaccine,3001069,CDM,636,RC,,,outpatient,,,204,102,,197.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,122.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,183.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,183.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,122.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,139.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,122.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,164.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,180.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,135.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,165.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,187.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,193.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,197.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,132.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,122.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,122.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,122.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,183.6,
HYDROCODONE/ACETAM(LORTAB7.5) 7.5/325MG,3001070,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
SEN/DOCUSATE(SENOKOT-S) TAB 8.6/50 MG,3001076,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
PETROLATUM(LACRILUBE) OPTH OINT 3.5GM,3001077,CDM,250,RC,,,outpatient,,,42.5,21.25,,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,39.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.5,90,
PHESEPTIC(CHLORASEPTIC SPRAY) LIQ 6oz,3001078,CDM,250,RC,,,outpatient,,,21.25,10.63,,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,90,
CEFTAZIDIME (TAZICEF) INJ 2 GM,3001079,CDM,250,RC,,,outpatient,,,28.5,14.25,,27.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.08,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,90,
DILTIAZEM (CARDIZEM CD) CAP 120 MG,3001081,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
LIDOCAINE/PRILOCAINE (EMLA) CREAM,3001082,CDM,250,RC,,,outpatient,,,25.75,12.88,,24.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,23.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.45,90,
AMLODIPINE (NORVASC) TAB 5 MG,3001083,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
PIPERACILLIN/TAZ (ZOSYN) INJ 2.25 GM,3001088,CDM,250,RC,,,outpatient,,,12,6,,11.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.9,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,
PIPERACILLIN/TAZ (ZOSYN) INJ 3.375 GM,3001089,CDM,250,RC,,,outpatient,,,12.25,6.13,,11.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.9,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,90,
SINCALIDE (KINEVAC) INJ 5 MCG,3001100,CDM,250,RC,,,outpatient,,,221.25,110.63,,214.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,132.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,199.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,199.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.98,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,151,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,132.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,178.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,196.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,146.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,179.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,203.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,210.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,214.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,143.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,132.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,132.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,199.13,
ACETAMINOPHEN(TYLENOL)160MG/5ML 120 ML,3001104,CDM,250,RC,,,outpatient,,,4.25,2.13,,4.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,4.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,90,
HEPARIN FLUSH 100 UNIT/ML 5 ML,3001105,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
FILGRASTIM INJ (NEUPOGEN) 300 MCG,3001110,CDM,250,RC,,,outpatient,,,1212,606,,1175.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,727.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1090.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1090.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,727.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,881.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,827.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,727.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,978.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,978.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1073.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,803.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,981.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1115.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,1151.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,1175.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,787.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,727.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,727.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,727.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1090.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,727.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,727.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1090.8,
"INSULIN, NPH (HUMULIN N) INJ 3 ML",3001114,CDM,250,RC,,,outpatient,,,17.25,8.63,,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,90,
CLOZEPAM (KLONOPIN) TAB 0.5 MG,3001119,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
EPOETIN ALFA (PROCRIT) 4000 UNITS/ML,3001120,CDM,250,RC,,,outpatient,,,223.75,111.88,,217.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,134.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,201.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,152.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,134.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,180.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,198.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,148.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,181.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,205.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,212.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,217.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,145.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,134.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,134.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,201.38,
FUROSEMIDE (LASIX) INJ 100 MG/10ML,3001121,CDM,250,RC,,,outpatient,,,6.5,3.25,,6.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,90,
LOPERAMIDE (IMODIUM) CAP 2 MG,3001122,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
EVACUATED CONTAINER 1000 ML,3001125,CDM,259,RC,,,outpatient,,,42.25,21.13,,40.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,38.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.35,90,
"INSULIN, 70/30 (HUMULIN 70/30)INJ 3 ML",3001133,CDM,250,RC,,,outpatient,,,17.25,8.63,,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,90,
METOCLOPRAMIDE (REGLAN) TAB 5 MG,3001136,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
ENOXAPARIN (LOVENOX) INJ 40 MG,3001138,CDM,250,RC,,,outpatient,,,12.25,6.13,,11.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.86,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,90,
AMIODARONE (CORDARONE) INJ 150 MG,3001139,CDM,250,RC,,,outpatient,,,3.25,1.63,,3.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.36,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,90,
GLIMEPIRIDE (AMARYL) TAB 2 MG,3001142,CDM,250,RC,,,outpatient,,,2,1,,1.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,1.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,1.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,1.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.2,90,
OLANZAPINE (ZYPREXA) O.D.T. 5 MG,3001145,CDM,250,RC,,,outpatient,,,3.5,1.75,,3.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,90,
PROTAMINE (HEMOCHRON) INJ 10MG/ML 25 ML,3001159,CDM,250,RC,,,outpatient,,,92,46,,89.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.13,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,82.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,62.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,74.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,84.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,55.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.2,90,
SODIUM CL(NORMAL SALINE) IRRIG 3000 ML,3001161,CDM,258,RC,,,outpatient,,,33,16.5,,32.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,29.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.8,90,
IBUPROFEN SUSP 100MG/5ML 120 ML,3001163,CDM,250,RC,,,outpatient,,,12.25,6.13,,11.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,90,
FENTANYL (DURAGESIC) PATCH 25 MCG/HR,3001168,CDM,250,RC,,,outpatient,,,9.5,4.75,,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.7,90,
LEVOFLOXACIN (LEVAQUIN) INJ 750 MG,3001169,CDM,250,RC,,,outpatient,,,13.25,6.63,,12.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.23,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,11.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.95,90,
LEVOFLOXACIN (LEVAQUIN) INJ 500 MG,3001171,CDM,250,RC,,,outpatient,,,8.25,4.13,,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.23,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,90,
LEVOFLOXACIN (LEVAQUIN) TAB 500 MG,3001172,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
PAROXETINE (PAXIL) TAB 20 MG,3001174,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
AMPICILLIN/SULBACTAM(USYN)INJ 3 GM,3001175,CDM,250,RC,,,outpatient,,,39.5,19.75,,38.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.15,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,36.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,37.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,38.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.7,90,
LEVOFLOXACIN (LEVAQUIN) INJ 250 MG,3001176,CDM,250,RC,,,outpatient,,,14.5,7.25,,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.23,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,90,
AMPICILLIN/SULBACTAM(USYN)INJ 1.5 GM,3001177,CDM,250,RC,,,outpatient,,,28.5,14.25,,27.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.15,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,90,
OFLOXACIN OPHTH DROPS (FLOXIN),3001178,CDM,250,RC,,,outpatient,,,17.75,8.88,,17.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,15.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.65,90,
OXYCODONE IR (OXY IR) TAB 5MG,3001181,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
FENTANYL (DURAGESIC) PATCH 50 MCG/HR,3001188,CDM,250,RC,,,outpatient,,,16.25,8.13,,15.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,90,
TOBRAMYCIN/DEX(TOBRADEX)OPHTH OINT 3.5GM,3001189,CDM,250,RC,,,outpatient,,,205,102.5,,198.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,123,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,184.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,184.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,123,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,139.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,123,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,165.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,181.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,135.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,166.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,188.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,194.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,198.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,133.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,123,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,123,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,123,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,184.5,
GLIPIZIDE (GLUCOTROL) TAB 5 MG,3001192,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
AZITHROMYCIN (ZITHROMAX) TAB 250 MG,3001195,CDM,250,RC,,,outpatient,,,4,2,,3.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,90,
WARFARIN (COUMADIN) TAB 1 MG,3001196,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
QUETIAPINE (SEROQUEL) TAB 100 MG,3001207,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
ERYTHROMYCIN EYE OINTADULT/NEWBORN 3.5GM,3001211,CDM,250,RC,,,outpatient,,,35.25,17.63,,34.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,31.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.15,90,
MIRTAZEPINE (REMERON) TAB 30 MG,3001212,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
DOXAZOSIN (CARDURA) TAB 2 MG,3001217,CDM,250,RC,,,outpatient,,,4.25,2.13,,4.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,4.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,90,
MAGNESIUM OXIDE (MAG-OX) TAB 400 MG,3001218,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
BUPROPION SR(WELLBUTRIN SR) TAB 150 MG,3001219,CDM,250,RC,,,outpatient,,,4,2,,3.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,90,
FERRIC GLUCOTE(FERRLECIT) INJ 62.5 MG,3001301,CDM,250,RC,,,outpatient,,,30.25,15.13,,29.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.69,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,27.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,27.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.15,90,
DIVALPROEX (DEPAKOTE ER) TAB 500 MG,3001302,CDM,250,RC,,,outpatient,,,11.5,5.75,,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,90,
ALBUTEROL/IPRATROPIUM(DUONEB) NEB 3 ML,3001303,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
ACETYLCYSTEINE AEROSOL 4 ML,3001305,CDM,250,RC,,,outpatient,,,16,8,,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.6,90,
NORMAL SALINE NEBULIZER 3 ML,3001306,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
IPRATROPIUM (ATROVENT) NEB 0.5MG/2.5ML,3001309,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
LEVALBUTEROL (XOPENEX) NEB 1.25 MG/3ML,3001310,CDM,250,RC,,,outpatient,,,6,3,,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.28,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,
LEVALBUTEROL (XOPENEX) NEB 0.63 MG/3ML,3001311,CDM,250,RC,,,outpatient,,,6,3,,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.28,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,
METHACHOLINE (PROVOCHOLINE) INH KIT,3001312,CDM,250,RC,,,outpatient,,,293.5,146.75,,284.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,176.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.69,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,264.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,264.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,176.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,200.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,176.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,236.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,236.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,260.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,194.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,237.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,270.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,278.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,284.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,190.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,176.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,264.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,176.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,176.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,264.15,
FISH OIL (LOVAZA) CAP 1000 MG,3001316,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
CYANOCOBALAMIN(VITAMIN B-12)TAB 100 MCG,3001317,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
WATER STERILE INJ 1000 ML,3001321,CDM,250,RC,,,outpatient,,,13.75,6.88,,13.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.25,90,
LIDOCAINE (LIDODERM) 5% PATCH 700MG,3001322,CDM,250,RC,,,outpatient,,,25.75,12.88,,24.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,23.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.45,90,
HYOSCYAMINE (LEVSIN) TAB 0.125 MG,3001323,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
GLIPIZIDE XL (GLUCOTROL XL) TAB 5 MG,3001325,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
TOPIRAMATE (TOPAMAX) TAB 25 MG,3001326,CDM,250,RC,,,outpatient,,,3.75,1.88,,3.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,90,
DULOXETINE (CYMBALTA) CAP 30 MG,3001331,CDM,250,RC,,,outpatient,,,3.25,1.63,,3.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.36,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,90,
LEVETIRACETAM (KEPPRA) TAB 500 MG,3001332,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
OLMESARTAN (BENICAR) TAB 20 MG,3001335,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
ALBUTEROL HFA (PROVENTIL)INH 6.7GM200MDI,3001338,CDM,250,RC,,,outpatient,,,60.25,30.13,,58.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,41.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,53.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,39.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,48.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,55.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,57.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,58.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,90,
SEN TAB 8.6 MG,3001339,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
OXYCONTIN CR (OXYCONTIN) TAB 10 MG,3001341,CDM,250,RC,,,outpatient,,,6.75,3.38,,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,90,
LEVOTHYROXINE (SYNTHROID) TAB 75 MCG,3001342,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
D5 1/4 NORMAL SALINE 20 KCL 1000 ML,3001345,CDM,258,RC,,,outpatient,,,16.75,8.38,,16.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,15.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.05,90,
POLYETHYLENE GLYCOL(MIRALAX) 17 GM PCKT,3001349,CDM,250,RC,,,outpatient,,,4.25,2.13,,4.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,4.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,90,
POLYCARBOPHYIL (FIBERCON) TAB 625 MG,3001351,CDM,250,RC,,,outpatient,,,4,2,,3.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,90,
"BACITRACIN INJ  50,000 UNITS",3001352,CDM,250,RC,,,outpatient,,,18.5,9.25,,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,90,
IMIPENEM/CILASTATIN(PRIMAXIN)INJ 500 MG,3001355,CDM,250,RC,,,outpatient,,,37,18.5,,35.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.38,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,34.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.2,90,
CALCITRIOL (ROCALTROL) CAP 0.25 MCG,3001356,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
ZOLEDRONIC ACID (RECLAST) INJ 5MG,3001357,CDM,250,RC,,,outpatient,,,313.75,156.88,,304.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,188.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,282.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,282.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,188.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,214.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,188.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,253.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,253.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,278.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,208.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,254.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,288.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,298.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,304.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,203.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,188.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,282.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,188.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,188.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,282.38,
METHYL SALICYLATE/MENTHOL  85GM,3001359,CDM,250,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,
SODIUM BICARBOTE TAB 325 MG,3001360,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
CHOLECALCIFEROL (VIT D3) TAB 1000 UNITS,3001415,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
MELOXICAM (MOBIC) TAB 7.5MG,3001420,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
CARVEDILOL (COREG) TAB 6.25 MG,3001425,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
ONDANSETRON  (ZOFRAN) O.D.T.  4 MG,3001430,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
LINEZOLID (ZYVOX) INJ 600MG/300ML,3001432,CDM,250,RC,,,outpatient,,,93.5,46.75,,90.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,84.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,75.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,86.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,88.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,90.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,90,
SORBITOL SOLUTION 70% 473 ML,3001451,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
ELAPRILAT INJ (VASOTEC) 2.5 MG/2ML,3001460,CDM,250,RC,,,outpatient,,,8.5,4.25,,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,90,
ACETIC ACID IRRIGATION 0.25% 1000ML,3001463,CDM,250,RC,,,outpatient,,,11.25,5.63,,10.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.75,90,
FLUOXETINE (PROZAC) CAP 10 MG,3001466,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
NORMAL SALINE 100 ML MINIBAG,3001467,CDM,258,RC,,,outpatient,,,24.25,12.13,,23.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,90,
MICOZOLE 2% OINT 150 GM,3001479,CDM,250,RC,,,outpatient,,,26.5,13.25,,25.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,23.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,90,
RABIES IMMUNE GOBULIN INJ 150U/ML 2ML,3001483,CDM,250,RC,,,outpatient,,,1595.25,797.63,,1547.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,957.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,280.64,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1435.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1435.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,957.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1160.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1088.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,957.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1287.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1287.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1413.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1057.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1292.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1467.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,1515.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,1547.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,1036.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,957.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,957.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,957.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1435.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,957.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,957.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1435.73,
BUDESONIDE (PULMICORT) NEB 0.5 MG,3001488,CDM,250,RC,,,outpatient,,,12.75,6.38,,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,
"INSULIN, DETEMIR (LEVEMIR) PEN 3 ML",3001490,CDM,250,RC,,,outpatient,,,112.5,56.25,,109.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,101.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,103.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,109.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,101.25,
ROPINIROLE (REQUIP) TAB 1 MG,3001496,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
BUPIVACAINE / EPI(SENSORCAINE)0.5% 30 ML,3001501,CDM,259,RC,,,outpatient,,,21.75,10.88,,21.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,21.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,90,
FENTANYL (DURAGESIC) PATCH 12 MCG/HR,3001509,CDM,250,RC,,,outpatient,,,37.5,18.75,,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,34.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,
HYDROGEN PEROXIDE 473 ML,3001518,CDM,270,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
LIDOCAINE 4% TOPICAL SOL 50 ML,3001520,CDM,250,RC,,,outpatient,,,94.25,47.13,,91.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,84.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,64.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,62.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,76.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,86.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,89.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,91.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.55,90,
POLYMYX/BACIT/NEOMYCIN OINT 28 GM,3001521,CDM,250,RC,,,outpatient,,,9.25,4.63,,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,90,
LIDOCAINE-MPF 1% EPI 1/200000/20 ML,3001522,CDM,250,RC,,,outpatient,,,30.25,15.13,,29.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,27.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,27.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.15,90,
FOSPHENYTOIN INJ(CEREBYX) 50MG PE/ML,3001523,CDM,250,RC,,,outpatient,,,18.5,9.25,,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.9,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,90,
CLINDAMYCIN (CLEOCIN) IVPB 900 MG/50ML,3001529,CDM,259,RC,,,outpatient,,,20.5,10.25,,19.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,18.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,18.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.3,90,
STRONG IODINE (LUGOL'S) SOLUTION 14 ML,3001534,CDM,250,RC,,,outpatient,,,93.5,46.75,,90.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,84.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,75.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,86.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,88.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,90.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,56.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,90,
FISH OIL CAP 1000 MG,3001535,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
HYALUROTE SODIUM (ORTHOVISC) 30MG/2ML,3001538,CDM,250,RC,,,outpatient,,,313,156.5,,303.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.13,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,281.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,281.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,213.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,252.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,277.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,207.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,253.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,287.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,297.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,303.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,203.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,281.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,187.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,281.7,
INSULIN ASPART (NOVOLOG) PEN 3 ML,3001543,CDM,259,RC,,,outpatient,,,62.25,31.13,,60.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,56.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,42.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,50.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,57.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,59.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,60.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,37.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.35,90,
REGADENOSON (LEXISCAN) 5 ML,3001544,CDM,250,RC,,,outpatient,,,496.25,248.13,,481.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,446.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,446.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,361.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,338.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,400.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,439.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,329.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,401.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,456.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,471.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,481.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,322.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,446.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,446.63,
PROPOFOL DRIP(DIPRIVAN)INJ 10MG/ML 100ML,3001545,CDM,250,RC,,,outpatient,,,49.5,24.75,,48.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,44.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,33.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,29.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,32.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,40.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,45.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,47.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,48.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,29.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,29.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.7,90,
"INSULIN DRIP, REG (HUMULIN) INJ 100 UNIT",3001548,CDM,250,RC,,,outpatient,,,18.75,9.38,,18.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,16.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,90,
DILTIAZEM (CARDIZEM) BOLUS 25MG/5ML,3001549,CDM,250,RC,,,outpatient,,,15.25,7.63,,14.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.15,90,
AMMONONIUM LACTATE LOTION 12% 400 GR,3001551,CDM,250,RC,,,outpatient,,,27.25,13.63,,26.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,24.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.35,90,
CEFEPIME (MAXIPIME) INJ 1 GM,3001552,CDM,250,RC,,,outpatient,,,11.75,5.88,,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.98,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,90,
CYANOCOBALAMIN(VITAMIN B-12)TAB 1000 MCG,3001557,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
CHLORTHALIDONE (HYGROTON) 25 MG,3001563,CDM,259,RC,,,outpatient,,,6,3,,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,
COLLAGESE (SANTYL) OINT 30GM,3001569,CDM,250,RC,,,outpatient,,,474.5,237.25,,460.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,284.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,427.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,427.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,284.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,345.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,323.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,284.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,383.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,383.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,420.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,314.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,384.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,436.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,450.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,460.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,308.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,284.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,284.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,284.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,427.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,284.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,284.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,427.05,
SCOPOLAMINE PATCH 1.5MG/72HRS,3001671,CDM,250,RC,,,outpatient,,,41,20.5,,39.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,36.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,24.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.6,90,
MASTISOL LIQUID ADHESIVE 2/3 ML,3001725,CDM,259,RC,,,outpatient,,,7.25,3.63,,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.35,90,
"CHOLECALCIFEROL (VIT D3) CAP 50,000 UN",3001739,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
CETIRIZINE SYRUP(ZYRTEC)120 ML,3001795,CDM,250,RC,,,outpatient,,,17.75,8.88,,17.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,15.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.65,90,
THROMBIN (FLOSEAL) 10 ML,3001811,CDM,250,RC,,,outpatient,,,1007.5,503.75,,977.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,604.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,302.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,906.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,906.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,604.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,733.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,687.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,604.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,813.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,813.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,892.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,667.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,816.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,926.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,957.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,977.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,654.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,604.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,604.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,604.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,906.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,604.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,604.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,906.75,
ENOXAPARIN (LOVENOX) INJ 30 MG,3001829,CDM,250,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.86,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,
SODIUM POTASSIUM PHOSPORUS PACKET 1.5 GM,3001927,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
CEFtriaxONE (ROCEPHIN) IM ONLY 1 GM,3001940,CDM,250,RC,,,outpatient,,,4,2,,3.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,90,
DILAUDID INJECTION 1MG/ML 1ML,3002033,CDM,250,RC,,,outpatient,,,12.25,6.13,,11.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.79,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,90,
MORPHINE SULFATE ORAL LIQ 10MG/5ML 10MG,3002046,CDM,250,RC,,,outpatient,,,6,3,,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,
ALTEPLASE (CATHFLO) INJ 2 MG,3002243,CDM,259,RC,,,outpatient,,,186.5,93.25,,180.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.14,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,167.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,167.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,127.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,111.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,165.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,123.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,151.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,171.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,177.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,180.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,111.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,111.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,167.85,
FLUCOZOLE (DIFLUCAN) IVPB 200MG/100ML,3002269,CDM,259,RC,,,outpatient,,,16.75,8.38,,16.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.9,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,15.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.05,90,
MAGNESIUM SULFATE IVPB 2GM/50ML,3002280,CDM,250,RC,,,outpatient,,,38.25,19.13,,37.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,35.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,36.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.95,90,
BA BAG,3002346,CDM,259,RC,,,outpatient,,,147.75,73.88,,143.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,132.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,100.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,88.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,97.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,119.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,135.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,140.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,143.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,88.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,88.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,132.98,
NORMAL SALINE  ***CHILLED*** 250ML,3002833,CDM,259,RC,,,outpatient,,,11.5,5.75,,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,90,
LIDOCAINE 5% OINTMENT 35 GM,3003061,CDM,259,RC,,,outpatient,,,146,73,,141.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,131.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,99.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,87.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,117.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,129.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,96.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,118.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,134.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,138.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,141.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,87.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,87.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,131.4,
ERTAPENEM (INVANZ) INJ 1 GM,3003131,CDM,250,RC,,,outpatient,,,153.75,76.88,,149.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,138.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,138.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,104.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,124.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,101.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,124.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,141.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,146.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,149.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,138.38,
DEXTROSE 5% 250 ML,3003185,CDM,258,RC,,,outpatient,,,11.5,5.75,,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.9,90,
FAMOTIDINE (PEPCID) IVPB 20MG/50ML,3003205,CDM,259,RC,,,outpatient,,,11.75,5.88,,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.05,90,
CHLORHEXIDINE 4% SOLUTION 118 ML,3003218,CDM,259,RC,,,outpatient,,,16,8,,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.6,90,
HETASTARCH (HESPAN) IN NS 500 ML,3003230,CDM,250,RC,,,outpatient,,,48.25,24.13,,46.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,43.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,39.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,44.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,45.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,46.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.95,90,
POLYETHYLENE GLYCOL(MIRALAX) 8.3OZ(238G),3003237,CDM,250,RC,,,outpatient,,,18.25,9.13,,17.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,90,
ELAPRILAT INJ (VASOTEC) 1.25 MG/ML,3003253,CDM,250,RC,,,outpatient,,,14,7,,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,90,
SODIUM CHLORIDE TABLETS 1000 MG,3003334,CDM,259,RC,,,outpatient,,,5,2.5,,4.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,4.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,90,
SODIUM PHOSPHATE 3 mmol P/ML INJ 5 ML,3003341,CDM,250,RC,,,outpatient,,,36.25,18.13,,35.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,32.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,33.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,21.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.75,90,
IODINE/POVIDONE 7.5%(BETADINE)SCRUB 4OZ,3003345,CDM,250,RC,,,outpatient,,,12.25,6.13,,11.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,90,
HEPATITIS B IMMUNE GLOBULIN 1 ML,3003402,CDM,250,RC,,,outpatient,,,348.5,174.25,,338.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,209.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,313.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,253.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,237.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,209.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,281.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,281.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,308.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,231.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,282.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,320.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,331.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,338.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,226.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,209.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,209.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,313.65,
LAMOTRIGINE (LAMICTAL) TAB 25 MG,3003405,CDM,259,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
NORMAL SALINE 50 ML IVPB,3003406,CDM,258,RC,,,outpatient,,,10.25,5.13,,9.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.15,90,
NORMAL SALINE 100 ML IVPB,3003409,CDM,250,RC,,,outpatient,,,10.25,5.13,,9.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,9.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.15,90,
NORMAL SALINE 250 ML IVPB,3003424,CDM,258,RC,,,outpatient,,,5.5,2.75,,5.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,90,
FENTANYL (SUBLIMAZE) INJ 1000 MCG-DRIP,3003427,CDM,250,RC,,,outpatient,,,28,14,,27.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,90,
NORMAL SALINE 500 ML IVPB,3003436,CDM,258,RC,,,outpatient,,,5.75,2.88,,5.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,90,
POTASSIUM CHLORIDE IVPB 10 MEQ/100ML,3003440,CDM,250,RC,,,outpatient,,,12,6,,11.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.14,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,
DEXTROSE 5% WATER (D5W) 1000ML,3003442,CDM,258,RC,,,outpatient,,,9.25,4.63,,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.77,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,90,
D5 1/4 NORMAL SALINE 1000 ML,3003445,CDM,258,RC,,,outpatient,,,28,14,,27.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,90,
D5 1/2 NORMAL SALINE 1000 ML,3003448,CDM,258,RC,,,outpatient,,,8.5,4.25,,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,90,
D5 NORMAL SALINE 1000 ML,3003451,CDM,250,RC,,,outpatient,,,7,3.5,,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,90,
1/2 NORMAL SALINE 20 KCL 1000 ML,3003453,CDM,258,RC,,,outpatient,,,13,6.5,,12.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,90,
1/2 NORMAL SALINE 1000 ML,3003454,CDM,258,RC,,,outpatient,,,7,3.5,,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,90,
NORMAL SALINE 1000 ML,3003457,CDM,258,RC,,,outpatient,,,12.75,6.38,,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,
NORMAL SALINE 20 KCL 1000 ML,3003458,CDM,258,RC,,,outpatient,,,9.25,4.63,,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,90,
LACTATED RINGERS INJ 1000 ML,3003460,CDM,258,RC,,,outpatient,,,7,3.5,,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,90,
MIDAZOLAM (VERSED) DRIP 1MG/ML 100ML,3003462,CDM,250,RC,,,outpatient,,,45.75,22.88,,44.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,41.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,37.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,42.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,27.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.45,90,
D5 LACTATED RINGERS 1000 ML,3003463,CDM,258,RC,,,outpatient,,,21,10.5,,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,90,
LIDOCAINE 2GM/500ML INJ IVPB,3003472,CDM,250,RC,,,outpatient,,,9.25,4.63,,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,90,
D5 1/2 NORMAL SALINE 10 KCL 1000 ML,3003474,CDM,258,RC,,,outpatient,,,5.25,2.63,,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,90,
D5 1/2 NORMAL SALINE 20 KCL 1000 ML,3003475,CDM,258,RC,,,outpatient,,,26.25,13.13,,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,90,
NORMAL SALINE 40 KCL 1000 ML,3003476,CDM,258,RC,,,outpatient,,,12.75,6.38,,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,
D5 1/2 NORMAL SALINE 40 KCL 1000 ML,3003477,CDM,258,RC,,,outpatient,,,12,6,,11.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,
DEXTROSE 10% 1000 ML,3003481,CDM,258,RC,,,outpatient,,,8.25,4.13,,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,90,
DILAUDID INJECTION 0.5MG/0.5ML 0.5ML,3003483,CDM,250,RC,,,outpatient,,,13,6.5,,12.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.79,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,90,
DEXTROSE 50% PARTIAL FILL 500 ML,3003485,CDM,258,RC,,,outpatient,,,50.25,25.13,,48.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,45.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,40.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,46.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,47.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,48.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,90,
NORMAL SALINE 250 ML ADDVANTAGE,3003486,CDM,258,RC,,,outpatient,,,9.25,4.63,,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,90,
AMINO ACID 10% (TRAVASOL) IV 500 ML,3003487,CDM,258,RC,,,outpatient,,,27,13.5,,26.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,24.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.2,90,
AMINO ACID 5% /DEXTROSE 20%  & LYTES 1L,3003542,CDM,250,RC,,,outpatient,,,144,72,,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,116.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,136.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,129.6,
HYDROCODONE/ACETA(NORCO)7.5/325MG/15 ML,3003570,CDM,250,RC,,,outpatient,,,12.75,6.38,,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,
ALVIMOPAM (ENTEREG) CAPSULE 12 MG,3003600,CDM,250,RC,,,outpatient,,,363.25,181.63,,352.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,217.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,326.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,326.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,217.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,264.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,247.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,217.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,293.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,293.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,321.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,240.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,294.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,334.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,345.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,352.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,236.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,217.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,217.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,217.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,326.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,217.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,217.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,326.93,
EPTIFIBATIDE(INTEGRILIN)INJ 20MG/10ML,3003601,CDM,250,RC,,,outpatient,,,68,34,,65.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,61.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,45.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,55.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,62.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,65.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.8,90,
EPTIFIBATIDE(INTEGRILIN)INJ 75MG/100ML,3003603,CDM,250,RC,,,outpatient,,,113.5,56.75,,110.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,102.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,102.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,75.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,104.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,107.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,110.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.15,
METRONIDAZOLE (FLAGYL) TAB 500 MG,3003640,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
MANNITOL (OSMITROL) 20% INJ 500 ML,3003668,CDM,250,RC,,,outpatient,,,79.25,39.63,,76.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,72.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,76.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.55,90,
GUAIFENESIN/CODEINE (AC) SOL 10MG/5 ML,3003688,CDM,259,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
CLINDAMYCIN (CLEOCIN) IVPB 600 MG/50ML,3003748,CDM,259,RC,,,outpatient,,,32.25,16.13,,31.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,29.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,29.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,30.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,31.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.35,90,
CIPRO/DEXA (CIPRODEX) OTIC DROPS 7.5 ML,3003932,CDM,250,RC,,,outpatient,,,150.5,75.25,,145.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,135.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,90.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135.45,
NORMAL SALINE FLUSH(SALINE) INJ 10 ML,3003960,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
TERAZOSIN (HYTRIN) CAP 5 MG,3004000,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
TRAMadol (ULTRAM) TAB 50MG,3004003,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
SERTRALINE (ZOLOFT) TAB 100 MG,3004006,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
ZOLPIDEM (AMBIEN) TAB 5 MG,3004007,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
RANOLAZINE (RANEXA) ER TAB 500 MG,3004013,CDM,250,RC,,,outpatient,,,3.75,1.88,,3.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,90,
SITAGLIPTIN (JANUVIA) TAB 100 MG,3004035,CDM,250,RC,,,outpatient,,,48,24,,46.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,43.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,38.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,44.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,45.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,46.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.8,90,
RAPID SEQUENCE INTUBATION DRUGS (RSI) 1,3004091,CDM,250,RC,,,outpatient,,,45.25,22.63,,43.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,40.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,41.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,42.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,43.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,27.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.15,90,
RIVAROXABAN (XARELTO) TAB 10 MG,3004114,CDM,259,RC,,,outpatient,,,39.25,19.63,,38.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,35.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,31.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,36.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,37.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,38.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.55,90,
CEFTRIAXONE (ROCEPHIN) INJ 250 MG,3004189,CDM,250,RC,,,outpatient,,,8.25,4.13,,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,90,
AMOX/CLA ES(augmentinES)600MG/42.9MG/5ML,3004190,CDM,250,RC,,,outpatient,,,21.25,10.63,,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,90,
LEVONORGESTREL (PLAN B) TAB 1.5 MG,3004265,CDM,250,RC,,,outpatient,,,158.25,79.13,,153.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,142.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,108.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,140.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,128.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,145.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,150.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,153.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,94.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,142.43,
CALCIUM CHLORIDE 1 GRAM INJ 10 ML,3004282,CDM,250,RC,,,outpatient,,,31,15.5,,30.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,90,
FILGRASTIM INJ (NEUPOGEN) 480 MCG,3004377,CDM,250,RC,,,outpatient,,,1088.25,544.13,,1055.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,652.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,979.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,979.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,652.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,791.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,742.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,652.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,878.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,878.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,964.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,721.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,881.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1001.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,1033.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,1055.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,707.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,652.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,652.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,652.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,979.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,652.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,652.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,979.43,
Rho (D) IMMUNE GLOBULIN (RhoGAM) 1500 IU,3004391,CDM,259,RC,,,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,77.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,102.86,100,,,Case rate,pays at 100% of fixed rate,,,,,Other,Not Separately reimbursable,100,102.86,
Flu shot-high dose for 2019-2020 flu season given by injection for people >65,3004591,CDM,636,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,102.86,
CEFAZOLIN (KEFZOL) D5W INJ 2 GM/50ML,3004595,CDM,250,RC,,,outpatient,,,29.25,14.63,,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.8,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,90,
KETOROLAC (TORADOL) TAB 10MG,3004632,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
PIPERACILLIN/TAZ (ZOSYN) INJ 4.5 GM,3004661,CDM,250,RC,,,outpatient,,,19.5,9.75,,18.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.9,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.7,90,
METHYLPREDNISOLONE(SOLU MEDROL)INJ 500MG,3004695,CDM,250,RC,,,outpatient,,,60.5,30.25,,58.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,54.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,41.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,36.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,53.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,40.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,49.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,55.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,57.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,58.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,36.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,36.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.3,90,
AMIODARONE (NEXTERONE)BOLUS 150 MG/100ML,3004802,CDM,250,RC,,,outpatient,,,137,68.5,,132.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,90.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,110.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,132.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,82.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.3,
AMIODARONE (NEXTERONE)DRIP 360 MG/200ML,3004803,CDM,250,RC,,,outpatient,,,181.75,90.88,,176.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,163.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,124.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,161.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,147.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,167.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,176.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.58,
ATROPINE EYE DROPS 1% 5ML,3004811,CDM,250,RC,,,outpatient,,,166.75,83.38,,161.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,161.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.08,
SALIVA SUBSTITUTE SPRAY 59 ML,3004844,CDM,259,RC,,,outpatient,,,24.5,12.25,,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.7,90,
HYDROCODONE/ACETAMIN(LORTAB 5) 5/325MG,3004902,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
FERRIC SUBSULFATE (MONSELS SOL) 10 ML,3004995,CDM,259,RC,,,outpatient,,,17.75,8.88,,17.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,15.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.65,90,
HYDROCODONE/ACETAMIN(NORCO 10) 10/325MG,3005043,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
LIDOCAINE FOR ED 1% (XYLOCAINE) INJ 2ML,3005058,CDM,250,RC,,,outpatient,,,20.5,10.25,,19.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,18.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,18.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.3,90,
ACETAMINOPHEN (OFIRMEV) INJ 1000 MG,3005107,CDM,250,RC,,,outpatient,,,26.75,13.38,,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,90,
DILAUDID PCA INJECTION 0.2MG/ML 30 ML,3005127,CDM,250,RC,,,outpatient,,,84.75,42.38,,82.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.79,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,76.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,57.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,68.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,77.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,80.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,82.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,50.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,90,
LIDOCAINE 2% SDV(XYLOCAINE) 5 ML,3005192,CDM,250,RC,,,outpatient,,,6,3,,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,
DAPTOMYCIN (CUBICIN) INJ 500MG,3005257,CDM,250,RC,,,outpatient,,,120,60,,116.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,108,90,,,percent of total billed charges,Pays at 90% of total billed charges,108,90,,,percent of total billed charges,Pays at 90% of total billed charges,72,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,81.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,114,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,78,65,,,percent of total billed charges,Pays at 65% of total billed charges,72,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108,90,,,percent of total billed charges,Pays at 90% of total billed charges,72,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,72,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108,
PROXEN (PROSYN) TAB 500 MG,3005271,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
LEVETIRACETAM (KEPPRA) INJ 500MG/5 ML,3005299,CDM,250,RC,,,outpatient,,,6.25,3.13,,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,90,
ACETAZOLAMIDE(DIAMOX)TAB 250 MG,3005414,CDM,250,RC,,,outpatient,,,11,5.5,,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,90,
TETRACAINE(PONTOCAINE) 0.5% EYE DPS 4 ML,3005459,CDM,250,RC,,,outpatient,,,17.25,8.63,,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,90,
PNEUMOCCOCAL 13 (PREVR) INJ 0.5ML,3005778,CDM,636,RC,,,outpatient,,,396.25,198.13,,384.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,237.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,356.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,356.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,237.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,288.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,270.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,237.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,319.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,319.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,351.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,262.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,320.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,364.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,376.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,384.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,257.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,237.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,237.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,237.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,356.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,237.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,237.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,356.63,
AMOXICILLIN (AMOXIL) SUSP 400MG/5ML100ML,3005809,CDM,250,RC,,,outpatient,,,8.5,4.25,,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.1,90,
TRANEXAMIC ACID(TXA) INJ 10 ML,3005901,CDM,259,RC,,,outpatient,,,18.5,9.25,,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,90,
"RETINYL PALMITATE(VITAMIN A) 10,000 UNIT",3006010,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
IMIPENEM/CILASTATIN(PRIMAXIN)INJ 250 MG,3006092,CDM,250,RC,,,outpatient,,,20.75,10.38,,20.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.38,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,90,
TRIMETHO/POLYMYXIN(POLYTRIM) OPHTH 10 ML,3006205,CDM,250,RC,,,outpatient,,,31,15.5,,30.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,90,
ESMOLOL (BREVIBLOC) 100MG/10 ML,3006248,CDM,250,RC,,,outpatient,,,12.25,6.13,,11.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.35,90,
CHLOROPROCAINE(NESACAINE)1% INJ 30 ML,3006393,CDM,250,RC,,,outpatient,,,62.5,31.25,,60.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.25,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,56.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,42.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,50.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,57.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,59.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,60.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,37.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.5,90,
METOPROLOL SUCCITE (TOPROL XL) TAB 50,3006440,CDM,250,RC,,,outpatient,,,3.25,1.63,,3.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.36,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,90,
FOSFOMYCIN (MONUROL) PWDR 3 GRAMS,3006468,CDM,250,RC,,,outpatient,,,141.5,70.75,,137.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,127.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,130.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,134.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,84.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,127.35,
CEFAZOLIN (KEFZOL) D5W INJ 1 GM/50ML,3006505,CDM,250,RC,,,outpatient,,,39.75,19.88,,38.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.8,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,35.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,23.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,36.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,37.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,38.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,23.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.85,90,
A biologic medication,3006526,CDM,341,RC,,,outpatient,,,2263,1131.5,,2195.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,1357.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2036.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2036.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1357.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1646.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1544.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1357.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1826.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1826.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2005.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1500.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1833.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2081.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,2149.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2195.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,1470.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1357.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1357.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1357.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2036.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1357.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1357.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2036.7,
INFLIXIMAB DYYB (INFLECTRA) INJ 100 MG,3006527,CDM,250,RC,,,outpatient,,,1314.5,657.25,,1275.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,788.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1183.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1183.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,788.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,956.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,897.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,788.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1061.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1061.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1164.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,871.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1064.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1209.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,1248.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,1275.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,854.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,788.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,788.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,788.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1183.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,788.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,788.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1183.05,
LIDOCAINE VISCOUS(XYLOCAINE)SYRUP 100ML,3006551,CDM,250,RC,,,outpatient,,,26,13,,25.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,23.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.6,90,
VIAL MATE ADAPTOR(VIAL MATE) 1 UN,3006608,CDM,250,RC,,,outpatient,,,7,3.5,,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,90,
ORITAVANCIN(ORBACTIV)INJ 400 MG,3006614,CDM,250,RC,,,outpatient,,,2242,1121,,2174.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,1345.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2017.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2017.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1345.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1631.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1530.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1345.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1809.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1809.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1986.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1486.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1816.02,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2062.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,2129.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,2174.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,1457.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,1345.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1345.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1345.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2017.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1345.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1345.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2017.8,
CLOBETASOL (TEMOVATE) GEL 0.05% 15 GM,3006661,CDM,250,RC,,,outpatient,,,207.5,103.75,,201.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,186.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,186.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,124.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.98,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,141.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,124.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,167.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,183.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,137.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,168.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,190.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,197.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,201.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,134.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,124.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,124.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,124.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,186.75,
SILVER NITRATE SWAB 1 SWAB,3006970,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
TRUVADA/ISENTRISS (HIV PROPH) 1 EA,3006973,CDM,250,RC,,,outpatient,,,720.5,360.25,,698.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,432.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,216.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,648.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,648.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,432.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,524.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,491.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,432.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,581.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,581.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,638.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,477.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,583.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,662.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,684.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,698.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,468.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,432.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,432.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,432.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,648.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,432.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,432.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,648.45,
APIXABAN (ELIQUIS)TAB 5 MG,3007237,CDM,259,RC,,,outpatient,,,20.75,10.38,,20.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,90,
ATORVASTATIN(LIPITOR)TAB 20 MG,3007462,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
PREDNISOLONE ORAL SOLUTION 15MG/5ML,3007585,CDM,250,RC,,,outpatient,,,8,4,,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.09,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,90,
HYDROXYQUINOLINE SULFATE(BAG BALM) 8OZ,3007589,CDM,259,RC,,,outpatient,,,26.25,13.13,,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,90,
MEROPENEM(MERREM)INJ 1000 MG,3008335,CDM,250,RC,,,outpatient,,,21.5,10.75,,20.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.94,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.9,90,
CEFTAROLINE (TEFLARO) INJ 400 MG,3008340,CDM,250,RC,,,outpatient,,,388.25,194.13,,376.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,232.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.32,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,349.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,349.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,282.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,264.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,232.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,313.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,344.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,257.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,314.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,357.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,368.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,376.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,252.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,232.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,349.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,232.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,349.43,
MEROPENEM(MERREM)INJ 500 MG,3008347,CDM,250,RC,,,outpatient,,,21.25,10.63,,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.94,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.75,90,
FLUCOZOLE (DIFLUCAN) TAB 100 MG,3008349,CDM,250,RC,,,outpatient,,,5,2.5,,4.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,4.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,90,
LEVONORGESTREL IUD(SKYLA) 14MCG/24HR,3008425,CDM,250,RC,,,outpatient,,,1712.25,856.13,,1660.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,1027.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,793.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1541.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,1541.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,1027.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1245.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1168.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1027.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1382.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1382.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1517.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1135.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1386.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1575.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,1626.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,1660.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,1112.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,1027.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1027.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1027.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1541.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,1027.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1027.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1541.03,
COPPER IUD(PARAGARD) 313.4 MG,3008426,CDM,636,RC,,,outpatient,,,1664,832,,1614.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,998.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,808.5,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1497.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,1497.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,998.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1210.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1135.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,998.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1343.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1343.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1474.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1103.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1347.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1530.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,1580.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,1614.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,1081.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,998.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,998.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,998.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1497.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,998.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,998.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1497.6,
INFLUENZA-EGG FREE VACCINE (FLUBLOK 18+),3008523,CDM,636,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,102.86,
INFLUENZA HD 65 YEARS + VACCINE 0.5ML,3008524,CDM,636,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,102.86,
FERUMOXYTOL(FERAHEME)INJ 510 MG,3008643,CDM,250,RC,,,outpatient,,,2096.25,1048.13,,2033.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,1257.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.04,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1886.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,1886.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,1257.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1525.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1430.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1257.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1692.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1692.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1857.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1389.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1697.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1928.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,1991.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,2033.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,1362.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,1257.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1257.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1257.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1886.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,1257.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1257.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1886.63,
SACCHAROMYCES (FLORASTOR) CAP 250 MG,3009103,CDM,250,RC,,,outpatient,,,3.75,1.88,,3.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,90,
FORMOTEROL(PERFOROMIST) NEB 20MCG/2ML,3009245,CDM,250,RC,,,outpatient,,,16,8,,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.6,90,
SUGAMMADEX (BRIDION) INJ 2 ML,3009385,CDM,250,RC,,,outpatient,,,222.5,111.25,,215.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,133.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,200.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,151.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,133.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,179.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,179.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,197.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,147.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,180.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,204.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,211.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,215.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,144.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,133.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,133.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,200.25,
SODIUM HYPOCHLOR(DAKINS 1/2 STR) 473 ML,3009471,CDM,258,RC,,,outpatient,,,39,19.5,,37.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,35.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,23.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,31.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,35.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,37.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,23.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.4,90,
BACITRACIN/POLYMYXIN OPHTH OINT 3.5 GM,3009575,CDM,250,RC,,,outpatient,,,17.5,8.75,,16.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,15.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.5,90,
OSELTAMIVIR (TAMIFLU) 30 MG CAP,3009734,CDM,250,RC,,,outpatient,,,15.5,7.75,,15.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,90,
MORPHINE IR (MSIR) TAB 30 MG,3009916,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
MORPHINE SR (MS CONTIN) TAB 15 MG,3009917,CDM,250,RC,,,outpatient,,,3.25,1.63,,3.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.36,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,90,
CALCITONIN SALMON (FORTICAL) SAL 3.7ML,3009919,CDM,250,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,90,
DONEPEZIL (ARICEPT) TAB 10 MG,3009923,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
DIPHENHYDRAMINE(BEDRYL)ELIX 12.5MG/5ML,3009928,CDM,250,RC,,,outpatient,,,4.25,2.13,,4.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,4.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,90,
FAT EMULSION 20% INJ 250 ML,3009929,CDM,250,RC,,,outpatient,,,14,7,,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.4,90,
SUMATRIPTAN (IMITREX) INJ 6 MG,3009930,CDM,250,RC,,,outpatient,,,26.25,13.13,,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,90,
GABAPENTIN (NEURONTIN) CAP 300 MG,3009932,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
GABAPENTIN (NEURONTIN) CAP 400 MG,3009933,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
GABAPENTIN (NEURONTIN) CAP 100 MG,3009937,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
HYDROCORTISONE (ANUSOL HC) 2.5% CRM 30GM,3009938,CDM,250,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,90,
LORAZEPAM (ATIVAN) INJ 2 MG/ML,3009944,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.68,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
BACLOFEN (LIORESAL) TAB 10MG,3009945,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
BETHANECHOL (URECHOLINE) TAB 10 MG,3009946,CDM,250,RC,,,outpatient,,,3.25,1.63,,3.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.36,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,90,
CELECOXIB (CELEBREX) CAP 100 MG,3009949,CDM,250,RC,,,outpatient,,,5.25,2.63,,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,90,
CLINDAMYCIN (CLEOCIN) CAP 150 MG,3009954,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
AMIODARONE (CORDARONE) TAB 200 MG,3009956,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
SALINE SAL SPRAY (OCEAN),3009957,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
FISTERIDE (PROSCAR) TAB 5MG,3009960,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
FLUMAZENIL (ROMAZECON) INJ 0.1MG/ML 5ML,3009962,CDM,250,RC,,,outpatient,,,21.5,10.75,,20.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.9,90,
METFORMIN (GLUCOPHAGE) TAB 500 MG,3009963,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
METFORMIN (GLUCOPHAGE) TAB 850 MG,3009964,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
GUAIFENESIN ER (MUCINEX) TAB 600MG,3009966,CDM,250,RC,,,outpatient,,,4,2,,3.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,90,
ISOSORBIDE MONONITRATE (IMDUR)TAB 60 MG,3009970,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
CLOTRIMAZOLE/BETAMET(LOTRISONE)CRM 15GM,3009976,CDM,250,RC,,,outpatient,,,77.5,38.75,,75.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,69.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,51.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,62.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,71.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,73.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,75.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.5,90,
METHOTREXATE TAB 2.5 MG,3009978,CDM,250,RC,,,outpatient,,,9.25,4.63,,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.25,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.55,90,
PRIMIDONE (MYSOLINE) TAB 50 MG,3009982,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
OXYBUTYININ (DITROPAN) TAB 5MG,3009986,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
RIFAMPIN (RIFADIN) CAP 150 MG,3009993,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
RISPERIDONE (RISPERDAL) TAB 1 MG,3009994,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
SODIUM ACETATE INJ 20 ML,3009997,CDM,250,RC,,,outpatient,,,8.75,4.38,,8.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.63,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,5.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,90,
TERAZOSIN (HYTRIN) CAP 1 MG,3009999,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
TRIAMCINOLONE 0.1% (ARISTOCORT) CR 80 GM,3010000,CDM,250,RC,,,outpatient,,,28.25,14.13,,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,90,
MELATONIN(SLEEP) TAB 3 MG,3010685,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
ACETYLCYSTEINE(ACETADOTE) INJ 2-2ND DOSE,3010777,CDM,636,RC,,,outpatient,,,239.25,119.63,,232.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,143.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.08,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,215.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,215.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,143.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,163.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,143.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,193.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,212,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,158.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,193.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,220.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,227.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,232.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,143.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,143.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,143.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,215.33,
ACETYLCYSTEINE(ACETADOTE) INJ 3-3RD DOSE,3010778,CDM,636,RC,,,outpatient,,,239.25,119.63,,232.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,143.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.08,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,215.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,215.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,143.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,163.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,143.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,193.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,212,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,158.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,193.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,220.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,227.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,232.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,143.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,143.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,143.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,215.33,
MAFENIDE ACETATE TOPICAL SOLN 5%,3010856,CDM,258,RC,,,outpatient,,,166.75,83.38,,161.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,161.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.08,
VENLAFAXINE (EFFEXOR XR) CAP 37.5 MG,3011087,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
PERMETHRIN(NIX) LOT 1% 59 ML,3011186,CDM,259,RC,,,outpatient,,,34.5,17.25,,33.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,31.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,32.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.7,90,
ALTEPLASE(ACTIVASE) INJ 100 MG/100ML,3011514,CDM,250,RC,,,outpatient,,,19210.75,9605.38,,18634.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,11526.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.14,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,17289.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,17289.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,11526.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13977.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13111.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11526.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15506.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15506.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17022.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12736.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15560.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17673.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,18250.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,18634.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,12486.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,11526.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11526.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11526.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17289.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,11526.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11526.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,17289.68,
TELAVANCIN (VIBATIV) INJ 750MG,3011940,CDM,250,RC,,,outpatient,,,903,451.5,,875.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,541.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.97,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,812.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,812.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,541.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,657.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,616.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,541.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,728.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,728.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,800.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,598.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,731.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,830.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,857.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,875.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,586.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,541.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,541.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,541.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,812.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,541.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,541.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,812.7,
CEFEPIME (MAXIPIME) INJ 2 GM,3012401,CDM,250,RC,,,outpatient,,,28.75,14.38,,27.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.98,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,90,
LEVONORGESTREL IUD(MIRE) 20MCG/24HR,3012568,CDM,250,RC,,,outpatient,,,2172.25,1086.13,,2107.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,1303.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,953.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1955.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,1955.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,1303.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1580.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1482.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1303.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1753.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1753.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1924.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1440.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1759.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1998.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,2063.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,2107.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,1411.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,1303.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1303.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1303.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1955.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,1303.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1303.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1955.03,
LIDOCAINE 0.5% SDV(XYLOCAINE) INJ 50ML,3012938,CDM,250,RC,,,outpatient,,,16.25,8.13,,15.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,90,
ROPIVACAINE 0.5% SDV(ROPIN) INJ 30ML,3012939,CDM,250,RC,,,outpatient,,,20,10,,19.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,18,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,90,,,percent of total billed charges,Pays at 90% of total billed charges,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,18.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,19,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,13,65,,,percent of total billed charges,Pays at 65% of total billed charges,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,Pays at 90% of total billed charges,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12,90,
ZOSTER VACCINE (SHINGRIX) 50MCG/0.5ML,3012940,CDM,636,RC,,,outpatient,,,311.25,155.63,,301.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.08,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,280.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,280.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,212.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,251.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,275.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,206.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,252.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,286.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,295.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,301.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,202.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,280.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,280.13,
CIPROFLOXACIN (CIPRO) INJ 400MG/200ML,3013166,CDM,250,RC,,,outpatient,,,28,14,,27.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.28,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.8,90,
ALBUMIN 5% INJ 12.5GM/250ML,3013398,CDM,250,RC,,,outpatient,,,153.75,76.88,,149.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,138.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,138.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,104.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,124.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,101.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,124.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,141.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,146.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,149.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,92.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,138.38,
NICARDIPINE (CARDENE) 25MG/10ML,3013618,CDM,250,RC,,,outpatient,,,60.5,30.25,,58.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,54.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,41.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,36.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,53.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,40.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,49.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,55.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,57.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,58.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,36.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,36.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.3,90,
NITROFURANTOIN (MACROBID) CAP 100 MG,3014005,CDM,250,RC,,,outpatient,,,5.5,2.75,,5.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,90,
LOXONE (RCAN) 4MG SAL SP 2 PK MAT,3014132,CDM,250,RC,,,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MIDAZOLAM (VERSED) INJ 1MG/ML 5ML,3014134,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.12,100,,,fee schedule,pays at 100% of Aetna Market Fee Schedule,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
FENTANYL INJ 50MCG/ML 5ML-CR ONLY,3014135,CDM,250,RC,,,outpatient,,,10,5,,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.93,100,,,fee schedule,pays at 100% of Aetna Market Fee Schedule,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,9.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,90,
DALBAVANCIN (DALVANCE) INJ 500MG VIAL,3014248,CDM,250,RC,,,outpatient,,,3288.5,1644.25,,3189.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,1973.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.54,100,,,fee schedule,pays at 100% of Aetna Market Fee Schedule,2959.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2959.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,1973.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2392.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2244.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1973.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2654.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2654.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2913.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2180.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2663.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3025.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,3124.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,3189.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,2137.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,1973.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1973.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1973.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2959.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,1973.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1973.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2959.65,
VANCOMYCIN (VANCOCIN) CAP 125 MG,3014771,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
EYE LUBRICANT OINTMENT 3.5GM,3015041,CDM,250,RC,,,outpatient,,,12.75,6.38,,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.65,90,
AMIKACIN 250MG/ML  4ML,3015064,CDM,250,RC,,,outpatient,,,29.5,14.75,,28.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.16,100,,,fee schedule,pays at 100% of Aetna Market Fee Schedule,26.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,27.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.7,90,
DENOSUMAB (PROLIA) 60MG/ML,3015328,CDM,250,RC,,,outpatient,,,2661.5,1330.75,,2581.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,1596.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.05,100,,,fee schedule,pays at 100% of Aetna Market Fee Schedule,2395.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,2395.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,1596.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1936.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1816.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1596.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2148.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2148.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2358.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1764.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2155.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2448.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,2528.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,2581.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,1729.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,1596.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1596.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1596.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2395.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,1596.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1596.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2395.35,
BUPRENORPHINE(SUBUTEX) 8MG SL TAB,3015620,CDM,250,RC,,,outpatient,,,5.75,2.88,,5.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.45,90,
DUPILUMAB (DUPIXENT) INJ 300 MG/2ML,3015722,CDM,250,RC,,,outpatient,,,3162.75,1581.38,,3067.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,1897.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,948.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2846.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2846.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1897.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2301.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2158.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1897.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2552.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2552.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2802.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2096.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2561.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2909.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,3004.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,3067.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,2055.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1897.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1897.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1897.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2846.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1897.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1897.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2846.48,
DEXMEDETOMIDINE (PRECEDEX)200MCG/50ML,3015723,CDM,258,RC,,,outpatient,,,90.25,45.13,,87.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,73.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,83.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,85.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,87.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,90,
CEFAZOLIN (KEFZOL)INJ 3GM/100ML,3015847,CDM,250,RC,,,outpatient,,,24.25,12.13,,23.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.8,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,90,
FLECAINIDE 100MG TAB,3015849,CDM,250,RC,,,outpatient,,,2.75,1.38,,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,90,
TIGECYCLINE (TYGACIL) INJ 50MG,3015889,CDM,250,RC,,,outpatient,,,163.75,81.88,,158.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,147.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,147.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,111.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,98.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,145.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,108.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,132.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,150.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,155.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,158.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,98.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,98.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,147.38,
FIDAXOMICIN (DIFICID) 200MG TABLET,3015999,CDM,250,RC,,,outpatient,,,203.5,101.75,,197.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,122.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,183.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,183.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,122.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,138.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,122.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,164.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,180.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,134.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,164.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,187.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,193.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,197.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,132.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,122.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,122.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,122.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,183.15,
CEFTAROLINE (TEFLARO) INJ 600MG,3016000,CDM,250,RC,,,outpatient,,,396.75,198.38,,384.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.32,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,357.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,357.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,288.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,270.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,320.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,351.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,263.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,321.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,365.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,376.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,384.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,257.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,357.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,357.08,
DEXMEDETOMIDINE (PRECEDEX) 80MCG/20ML,3016053,CDM,258,RC,,,outpatient,,,45.5,22.75,,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,41.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,90,
meningococcal Meningococcal conjugate vaccine,3016074,CDM,636,RC,,,outpatient,,,205.25,102.63,,199.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,123.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.5,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,184.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,184.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,140.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,123.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,165.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,181.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,136.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,166.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,188.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,194.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,199.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,133.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,123.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,123.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,184.73,
KETAMINE INJ 50MG/5ML,3016121,CDM,250,RC,,,outpatient,,,19.25,9.63,,18.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,17.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,18.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,11.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.55,90,
IVIG (PRIVIGEN) INJ 20 GM,3016128,CDM,250,RC,,,outpatient,,,3801.75,1900.88,,3687.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,2281.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3421.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,3421.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,2281.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2766.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2594.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2281.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3068.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3068.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3368.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2520.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3079.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3497.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,3611.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,3687.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,2471.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,2281.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2281.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2281.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3421.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,2281.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2281.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3421.58,
IVIG (PRIVIGEN) INJ 40 GM,3016129,CDM,250,RC,,,outpatient,,,6502.5,3251.25,,6307.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,3901.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,5852.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,5852.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,3901.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4731.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4437.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3901.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5248.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5248.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5761.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4311.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5267.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5982.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,6177.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,6307.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,4226.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,3901.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3901.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3901.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5852.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,3901.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3901.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,5852.25,
IVIG (PRIVIGEN) INJ 5 GM,3016130,CDM,250,RC,,,outpatient,,,950.5,475.25,,921.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,570.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,855.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,855.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,570.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,691.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,648.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,570.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,767.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,767.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,842.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,630.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,769.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,874.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,902.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,921.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,617.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,570.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,570.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,570.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,855.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,570.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,570.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,855.45,
OXACILLIN 2GRAM INJECTION,3016350,CDM,250,RC,,,outpatient,,,37.5,18.75,,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,34.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,
MELATONIN(SLEEP) TAB 3 MG,3016385,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
"EPOETIN ALFA (PROCRIT) 20,000 UNITS/ML",3016471,CDM,250,RC,,,outpatient,,,630.25,315.13,,611.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,378.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,567.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,567.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,378.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,458.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,430.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,378.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,508.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,508.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,558.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,417.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,510.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,579.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,598.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,611.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,409.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,378.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,378.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,378.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,567.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,378.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,378.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,567.23,
DTaP (DAPTACEL) 0.5ML IM,3016476,CDM,250,RC,,,outpatient,,,73,36.5,,70.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.2,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,65.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,49.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,48.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,59.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,67.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,69.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,70.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.8,102.86,
DTaP-IPV/Hib (PENTACEL),3016477,CDM,250,RC,,,outpatient,,,131.25,65.63,,127.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,118.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,106.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,120.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,124.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,127.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,78.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,118.13,
DTaP-IPV (QUADRACEL),3016479,CDM,250,RC,,,outpatient,,,151.25,75.63,,146.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,136.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,103.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,122.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,100.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,122.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,139.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,143.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,146.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,90.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,136.13,
HAEMOPH B POLYSAC CONJ VACCINE (ActHIB),3016480,CDM,250,RC,,,outpatient,,,35.75,17.88,,34.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,102.86,
ROTAVIRUS LIVE ORAL VACCINE (ROTATEQ),3016481,CDM,250,RC,,,outpatient,,,163.5,81.75,,158.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.1,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,147.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,147.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,111.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,98.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,131.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,144.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,108.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,132.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,150.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,155.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,158.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,98.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,98.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,147.15,
"Measles, mumps and rubella vaccine",3016483,CDM,250,RC,,,outpatient,,,157.25,78.63,,152.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,141.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,94.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.53,
HUMAN PAPILLOMAVIRUS 9-VALENT VACCINE,3016484,CDM,250,RC,,,outpatient,,,463.5,231.75,,449.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,278.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,417.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,417.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,278.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,337.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,316.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,278.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,374.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,374.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,410.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,307.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,375.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,426.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,440.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,449.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,301.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,278.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,278.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,278.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,417.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,278.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,278.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,417.15,
Varicella vaccine,3016485,CDM,250,RC,,,outpatient,,,289,144.5,,280.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,173.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,260.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,260.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,173.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,197.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,173.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,233.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,233.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,256.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,191.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,234.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,265.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,274.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,280.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,187.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,173.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,260.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,173.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,173.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,260.1,
"measlesMeasles, mumps, rubella and varicella vaccine",3016486,CDM,250,RC,,,outpatient,,,478.75,239.38,,464.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,287.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,430.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,430.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,287.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,348.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,326.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,287.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,386.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,386.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,424.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,317.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,387.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,440.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,454.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,464.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,311.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,287.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,430.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,287.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,287.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,430.88,
HYDROXYCHLOROQUINE (PLAQUENIL) 200MG TAB,3016547,CDM,250,RC,,,outpatient,,,4,2,,3.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,90,
EPINEPHRINE (ADRELIN) DRIP 15MG/250ML,3016608,CDM,250,RC,,,outpatient,,,58.25,29.13,,56.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,52.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,47.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,53.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,55.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,56.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,34.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.95,90,
VECURONIUM (NORCURON) DRIP 10MG/100ML,3016611,CDM,250,RC,,,outpatient,,,14.75,7.38,,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,14.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.85,90,
ROCURONIUM (ZEMURON) DRIP 100MG/100ML,3016614,CDM,250,RC,,,outpatient,,,13.5,6.75,,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,
ZINFLUENZA VAC QUAD 6-35MON(PEDS) 0.25ML,3016647,CDM,250,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,102.86,
ICTIVATED POLIO VACCINE,3016649,CDM,250,RC,,,outpatient,,,78,39,,75.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,70.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,53.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,46.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,51.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,63.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,71.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,74.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,75.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,46.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,46.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.8,102.86,
DTaP-hepB-IPV (PEDIARIX),3016650,CDM,250,RC,,,outpatient,,,165.25,82.63,,160.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.1,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,148.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,148.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,112.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,99.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,109.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,133.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,152.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,156.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,160.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,107.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,99.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,99.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,148.73,
Hepatitis A vaccition for adolescents and children,3016651,CDM,250,RC,,,outpatient,,,115.25,57.63,,111.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.73,
MICAFUNGIN 100MG INJ,3016950,CDM,250,RC,,,outpatient,,,114,57,,110.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.08,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,102.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,102.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,75.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,92.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,104.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,108.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,110.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.6,
NF-DUROLANE INJ GEL 20MG/1ML,3017019,CDM,259,RC,,,outpatient,,,1970.25,985.13,,1911.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,1182.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.58,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1773.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,1773.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,1182.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1433.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1344.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1182.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1590.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1590.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1745.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1306.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1595.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1812.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,1871.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,1911.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,1280.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,1182.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1182.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1182.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1773.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,1182.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1182.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1773.23,
PERMETHRIN(ELIMITE)CREAM 5% 60GR,3017085,CDM,259,RC,,,outpatient,,,63.5,31.75,,61.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,57.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,51.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,58.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,60.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,61.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,38.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.1,90,
NF-VIMPAT ORAL TABLET 50MG,3017097,CDM,259,RC,,,outpatient,,,39.25,19.63,,38.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,35.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,31.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,36.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,37.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,38.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.55,90,
sal flu vaccine,3017197,CDM,250,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,102.86,
NF-GRANIX SUBCUTANEOUS SOLUTION 480MCG/.,3017239,CDM,259,RC,,,outpatient,,,644.5,322.25,,625.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,386.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,580.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,580.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,386.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,468.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,439.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,386.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,520.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,520.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,571.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,427.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,522.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,592.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,612.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,625.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,418.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,386.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,386.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,386.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,580.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,386.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,386.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,580.05,
NF-ENTECAVIR ORAL TABLET 0.5MG,3017241,CDM,259,RC,,,outpatient,,,4,2,,3.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.4,90,
NF-DEXAMETHASONE ORAL TABLET 1MG,3017242,CDM,259,RC,,,outpatient,,,1.5,0.75,,1.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,1.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,0.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,0.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,1.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,1.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,0.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,0.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,90,
sal flu vaccine,3017287,CDM,250,RC,,,outpatient,,,0.01,0.01,,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,0.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,0.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,0.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,0.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,0.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,102.86,
Flu shot-high dose for 2019-2020 flu season given by injection for people >65,3017288,CDM,636,RC,,,outpatient,,,0.01,0.01,,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,0.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,0.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,0.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,0.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,0.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,102.86,
VFC DTaP (DAPTACEL) 0.5ML IM,3017330,CDM,250,RC,,,outpatient,,,0.01,0.01,,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.2,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,0.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,0.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,0.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,0.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,0.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,102.86,
VFC DTaP-IPV (QUADRACEL),3017331,CDM,250,RC,,,outpatient,,,0.01,0.01,,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,0.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,0.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,0.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,0.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,0.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,102.86,
VFC DTaP-IPV/Hib (PENTACEL),3017332,CDM,250,RC,,,outpatient,,,0.01,0.01,,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,0.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,0.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,0.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,0.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,0.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,102.86,
VFC HAEMOPH B POLYSACVAC (ACTHIB),3017333,CDM,250,RC,,,outpatient,,,0.01,0.01,,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,0.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,0.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,0.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,0.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,0.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,102.86,
VFC HEP B (ENGERIX-B) PEDIATRIC 0.5ML,3017334,CDM,250,RC,,,outpatient,,,0.01,0.01,,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.9,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,0.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,0.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,0.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,0.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,0.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,102.86,
"Measles, mumps and rubella vaccine",3017335,CDM,250,RC,,,outpatient,,,0.01,0.01,,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,0.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,0.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,0.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,0.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,0.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,102.86,
"measlesMeasles, mumps, rubella and varicella vaccine",3017336,CDM,250,RC,,,outpatient,,,0.01,0.01,,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,0.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,0.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,0.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,0.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,0.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,102.86,
meningococcal Meningococcal conjugate vaccine,3017337,CDM,636,RC,,,outpatient,,,0.01,0.01,,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.5,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,0.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,0.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,0.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,0.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,0.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,102.86,
Varicella vaccine,3017338,CDM,250,RC,,,outpatient,,,0.01,0.01,,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,0.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,0.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,0.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,0.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,0.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,102.86,
VFC DTaP-hepB-IPV (PEDIARIX),3017339,CDM,250,RC,,,outpatient,,,0.01,0.01,,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.1,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,0.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,0.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,0.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,0.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,0.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,102.86,
VFC ICTIVATED POLIO VACCINE,3017340,CDM,250,RC,,,outpatient,,,0.01,0.01,,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,0.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,0.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,0.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,0.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,0.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,102.86,
Hepatitis A vaccition for adolescents and children,3017341,CDM,250,RC,,,outpatient,,,0.01,0.01,,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,0.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,0.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,0.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,0.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,0.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,102.86,
VFC PNEUMOCCOCAL 13 (PREVR) INJ 0.5ML,3017346,CDM,636,RC,,,outpatient,,,0.01,0.01,,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,0.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,0.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,0.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,0.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,0.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,102.86,
VFC ROTAVIRUS LIVE ORAL VACCINE(ROTATEQ),3017347,CDM,250,RC,,,outpatient,,,0.01,0.01,,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.1,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,0.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,0.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,0.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,0.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,0.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,102.86,
"Diphtheria, tetanus acellular, and pertussis vaccine for adults",3017348,CDM,250,RC,,,outpatient,,,0.01,0.01,,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,0.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,0.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,0.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,0.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,0.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,102.86,
VFC HPV VACCINE (GARDASIL9),3017349,CDM,250,RC,,,outpatient,,,0.01,0.01,,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,0.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,0.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,0.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,0.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,0.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,102.86,
VFC DTaP (INFANRIX) 0.5ML IM,3017351,CDM,250,RC,,,outpatient,,,0.01,0.01,,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.2,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,0.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,0.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,0.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,0.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,0.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,102.86,
VFC DTaP-IPV (KINRIX),3017352,CDM,250,RC,,,outpatient,,,0.01,0.01,,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,0.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,0.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,0.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,0.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,0.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,102.86,
MELOXICAM (ANJESO) 30MG/ML INJ,3017521,CDM,250,RC,,,outpatient,,,190,95,,184.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,114,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57,30,,,percent of total billed charges,Pays at 30% of total billed charges,171,90,,,percent of total billed charges,Pays at 90% of total billed charges,171,90,,,percent of total billed charges,Pays at 90% of total billed charges,114,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,129.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,114,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,153.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,153.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,168.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,125.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,153.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,174.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,180.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,184.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,123.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,114,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171,90,,,percent of total billed charges,Pays at 90% of total billed charges,114,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,114,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,171,
REMDESIVIR 100MG INJECTION,3017557,CDM,250,RC,,,outpatient,,,1130.25,565.13,,1096.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,678.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,339.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,1017.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,1017.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,678.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,822.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,771.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,678.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,912.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,912.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1001.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,749.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,915.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1039.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,1073.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,1096.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,734.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,678.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,678.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,678.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1017.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,678.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,678.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1017.23,
BAMLANIVIMAB 700MG/20ML INJECTION,3017609,CDM,250,RC,,,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
NF-PFIZERPEN POWDER FOR INJ 20MILLIONU,3017626,CDM,259,RC,,,outpatient,,,98.25,49.13,,95.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,88.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,58.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,79.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,90.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,93.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,95.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,58.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,58.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.95,90,
PENICILLIN G POTASSIUM INJ 20MMU,3017631,CDM,250,RC,,,outpatient,,,114,57,,110.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,102.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,102.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,75.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,92.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,104.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,108.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,110.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.6,
NF-RENFLEXIS INTRAVENOUS PWD FOR SOLN 10,3017716,CDM,259,RC,,,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,55.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
IVIG (OCTAGAM)  INJ 30 GM/300ML,3017737,CDM,250,RC,,,outpatient,,,324,162,,314.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,291.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,291.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,221.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,261.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,261.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,214.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,262.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,298.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,307.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,314.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,210.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,291.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,194.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,291.6,
"measlesMeasles, mumps, rubella and varicella vaccine",3017892,CDM,250,RC,,,outpatient,,,0.01,0.01,,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,0.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,0.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,0.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,0.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,0.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,102.86,
HEPARIN INFUSION 25000 UNITS/250 ML,3018143,CDM,250,RC,,,outpatient,,,25.5,12.75,,24.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.3,90,
DOBUTAMINE (DOBUTREX) INJ 500 MG/250ML,3018144,CDM,250,RC,,,outpatient,,,28.75,14.38,,27.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.25,90,
DOPamine DRIP 1600MCG/ML 400MG/250ML,3018145,CDM,258,RC,,,outpatient,,,26.5,13.25,,25.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.79,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,23.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,15.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,90,
HYALUROTE SODIUM (DUROLANE) 60MG/3ML,3018146,CDM,250,RC,,,outpatient,,,1969.75,984.88,,1910.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,1181.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.58,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1772.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,1772.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,1181.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1433.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1344.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1181.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1589.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1589.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1745.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1305.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1595.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1812.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,1871.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,1910.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,1280.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,1181.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1181.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1181.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1772.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,1181.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1181.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1772.78,
ETESEVIMAB 1400MG/20ML INJECTION,3018216,CDM,250,RC,,,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
BAMLANIVIMAB+ETESEVIMAB 700MG/1400MG INJ,3018221,CDM,250,RC,,,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
VFC HAEMOPH B POLYSACVAC (PEDVAXHIB),3018242,CDM,250,RC,,,outpatient,,,0.01,0.01,,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,0.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,0.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,0.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,0.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,0.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,102.86,
A biologic medication,3018302,CDM,250,RC,,,outpatient,,,2473.75,1236.88,,2399.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,1484.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2226.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2226.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,1484.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1799.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1688.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1484.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1996.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1996.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2191.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1640.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2003.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2275.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,2350.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,2399.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,1607.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,1484.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1484.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1484.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2226.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,1484.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1484.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2226.38,
EPINEPHRINE 0.3MG (EPIPEN AUTO INJECTOR),3018372,CDM,250,RC,,,outpatient,,,606,303,,587.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,363.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,545.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,545.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,363.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,440.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,413.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,363.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,489.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,489.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,536.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,401.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,490.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,557.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,575.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,587.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,393.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,363.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,363.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,363.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,545.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,363.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,363.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,545.4,
EPINEPHRINE 0.15MG (EPIPEN JUNIOR),3018373,CDM,250,RC,,,outpatient,,,606,303,,587.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,363.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,545.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,545.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,363.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,440.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,413.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,363.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,489.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,489.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,536.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,401.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,490.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,557.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,575.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,587.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,393.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,363.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,363.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,363.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,545.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,363.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,363.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,545.4,
ASPIRIN SUPP 300 MG,3018640,CDM,250,RC,,,outpatient,,,5.25,2.63,,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,90,
IMDEVIMAB 120MG/ML 11.1ML INJ,3018919,CDM,250,RC,,,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CASIRIVIMAB+IMDEVIMAB 600MG/600MG,3018920,CDM,250,RC,,,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
LEUPROLIDE (LUPRON) INJ 45 MG,3018965,CDM,250,RC,,,outpatient,,,1628.5,814.25,,1579.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1320,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1465.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,1465.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1184.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1111.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1314.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1314.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1443.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1079.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1319.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1498.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,1547.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,1579.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,1058.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1465.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,977.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1465.65,
IRON SUCROSE (VENOFER) INJ 20MG/ML,3018986,CDM,250,RC,,,outpatient,,,107.1,53.55,,103.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.26,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.39,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.39,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.26,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.26,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,71.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.62,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.26,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.26,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.26,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.39,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.26,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,64.26,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,96.39,
ZOLEDRONIC ACID (ZOMETA) INJ 4MG,3019281,CDM,250,RC,,,outpatient,,,57.42,28.71,,55.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,51.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,34.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,46.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,52.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,54.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,55.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.32,65,,,percent of total billed charges,Pays at 65% of total billed charges,34.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,34.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.45,90,
CASIRIVIMAB-IMDEVIMAB 1200MG IN 50ML NS,3019315,CDM,250,RC,,,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MENB VACCINE - TRUMENBA 0.5ML,3019318,CDM,636,RC,,,outpatient,,,273.75,136.88,,265.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,246.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,246.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,186.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,220.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,220.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,242.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,181.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,221.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,251.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,260.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,265.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,177.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,246.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,164.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,246.38,
MECWY VACCINE - MENQUADFI 0.5ML,3019319,CDM,636,RC,,,outpatient,,,205.5,102.75,,199.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,123.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,184.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,184.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,140.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,123.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,165.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,136.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,166.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,189.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,195.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,199.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,133.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,123.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,123.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,184.95,
BARICITINIB (OLUMIANT) 2MG TABLET,3019345,CDM,250,RC,,,outpatient,,,166.5,83.25,,161.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,149.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,99.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,134.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,161.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,99.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,99.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,149.85,
LIDOCAINE JELLY URO-JET 2% 5 ML,3019414,CDM,250,RC,,,outpatient,,,16.5,8.25,,16.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,90,
DTaP-IPV/Hib-HepB (VAXELIS),3019415,CDM,250,RC,,,outpatient,,,246.5,123.25,,239.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,147.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,221.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,221.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,147.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,179.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,168.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,147.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,198.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,218.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,163.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,199.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,226.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,234.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,239.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,160.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,147.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,147.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,147.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,221.85,
VFC DTaP-IPV/Hib-HepB (VAXELIS),3019416,CDM,250,RC,,,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CASIRIVIMAB-IMDEVIMAB 300MG/300MG/VIAL,3019500,CDM,250,RC,,,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
POLIDOCANOL (ASCLERA) 1% 20MG/2ML INJ,3019528,CDM,250,RC,,,outpatient,,,72,36,,69.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,64.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,49.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,43.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,58.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,66.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,68.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,43.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,43.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.2,90,
FLUORIDE (DURAFLOR) 5%/5%,3019543,CDM,250,RC,,,outpatient,,,20,10,,19.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,30,,,percent of total billed charges,Pays at 30% of total billed charges,18,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,90,,,percent of total billed charges,Pays at 90% of total billed charges,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,18.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,19,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,13,65,,,percent of total billed charges,Pays at 65% of total billed charges,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,90,,,percent of total billed charges,Pays at 90% of total billed charges,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12,90,
PROCHLORPERAZINE (COMPAZINE)INJ 10MG/2ML,3019691,CDM,250,RC,,,outpatient,,,14.25,7.13,,13.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,90,
LEUPROLIDE (ELIGARD) INJ 45 MG,3019750,CDM,250,RC,,,outpatient,,,1436.5,718.25,,1393.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,861.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.45,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1292.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,1292.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,861.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1045.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,980.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,861.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1159.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1159.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1272.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,952.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1163.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1321.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,1364.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,1393.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,933.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,861.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,861.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,861.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1292.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,861.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,861.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1292.85,
WATER STERILE FOR INJECTION 2000 ML,3019784,CDM,250,RC,,,outpatient,,,14.25,7.13,,13.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,90,
CEFDINIR (OMNICEF) CAP 300 MG,3019832,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
ACETAMINOPHEN(TYLENOL)160MG/5ML 5 ML,3019850,CDM,250,RC,,,outpatient,,,4.25,2.13,,4.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,3.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,4.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.55,90,
SULFAME/TMP(BACTRIM)SUS 800MG/160MG/20ML,3019854,CDM,250,RC,,,outpatient,,,24.75,12.38,,24.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.85,90,
IBUPROFEN SUSP 100MG/5ML 5ML,3019855,CDM,250,RC,,,outpatient,,,2,1,,1.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,1.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,1.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,1.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.2,90,
GUAIFENESIN (ROBITUSSIN) 100MG/5ML  5ML,3019867,CDM,250,RC,,,outpatient,,,1.75,0.88,,1.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,1.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.27,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,1.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,1.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.05,90,
GUAIFENESINDM(ROBITUSSIN DM)100-10MG/5ML,3019868,CDM,250,RC,,,outpatient,,,6.25,3.13,,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.88,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,90,
Hepatitis B vaccine,3090746,CDM,250,RC,,,outpatient,,,121.5,60.75,,117.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,109.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,98.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,111.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,115.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,117.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,109.35,
BUPIVACAINE(SENSORCAINE) 0.25% INJ 30ML,3091031,CDM,250,RC,,,outpatient,,,5.5,2.75,,5.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,90,
DOXYCYCLINE (VIBRAMYCIN) CAP 100 MG,3091050,CDM,250,RC,,,outpatient,,,5.25,2.63,,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,4.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,90,
HEPARIN FLUSH 100 UNIT/ML 10 ML,3091060,CDM,636,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
MINERAL OIL 30 ML,3091097,CDM,250,RC,,,outpatient,,,3,1.5,,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,2.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.8,90,
DEXAMETHASONE (DECADRON) INJ 4 MG,3091134,CDM,250,RC,,,outpatient,,,3.25,1.63,,3.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.15,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.36,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,90,
INSERT PICC CATH < 5 YRS,3536568,CDM,761,RC,,,outpatient,,,1280.75,640.38,,1242.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.66,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1152.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1152.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,931.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,874.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1033.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1033.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1134.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,849.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1037.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1178.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,1216.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,1242.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,832.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1152.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1152.68,
INSERT PICC CATH > 5 YRS,3536569,CDM,761,RC,,,outpatient,,,1280.75,640.38,,1242.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1152.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1152.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,931.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,874.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1033.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1033.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1134.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,849.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1037.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1178.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,1216.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,1242.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,832.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1152.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1152.68,
MANOMETRIC STUDY W INTERP AND REPORT,3591010,CDM,750,RC,,,outpatient,,,518.5,259.25,,502.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,466.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,466.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,377.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,353.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,418.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,418.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,459.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,343.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,419.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,477.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,492.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,502.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,337.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,466.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,466.65,
HOLTER MONITOR CONNECT RECORD DISCONNECT,4009011,CDM,731,RC,,,outpatient,,,467,233.5,,452.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,280.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,420.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,420.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,420.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,280.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,339.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,318.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,280.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,376.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,376.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,413.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,309.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,378.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,429.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,443.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,452.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,303.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,280.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,280.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,280.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,420.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,280.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,280.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,420.3,
RHYTHM STRIP,4009014,CDM,730,RC,,,outpatient,,,52.5,26.25,,50.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,35.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,49.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,50.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.5,102.86,
HOLTER MONITOR 24 - 48 SCAN ALYSIS,4009016,CDM,731,RC,,,outpatient,,,518.5,259.25,,502.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,466.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,466.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,466.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,377.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,353.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,418.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,418.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,459.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,343.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,419.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,477.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,492.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,502.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,337.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,466.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,466.65,
EVENT MONITOR 30 DAY,4009020,CDM,731,RC,,,outpatient,,,182.75,91.38,,177.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,124.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,161.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,148.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,168.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,173.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,177.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,164.48,
EKG TRACING ONLY,4009100,CDM,730,RC,,,outpatient,,,130.75,65.38,,126.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,105.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,120.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,124.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117.68,
EKG TRACING ONLY 15 LEAD,4009101,CDM,730,RC,,,outpatient,,,130.75,65.38,,126.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,105.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,120.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,124.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117.68,
US GUIDANCE NEEDLE PLACEMENT ABD,4400942,CDM,402,RC,,,outpatient,,,869,434.5,,842.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.2,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,782.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,782.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,632.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,593.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,701.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,701.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,770.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,576.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,703.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,799.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,825.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,842.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,564.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,782.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,782.1,
A diagnostic procedure that allows a provider to see the organs and other structures in the abdomen,4476705,CDM,402,RC,,,outpatient,,,491,245.5,,476.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,294.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,441.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,441.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,294.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,357.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,335.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,294.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,396.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,396.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,435.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,325.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,397.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,451.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,466.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,476.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,319.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,294.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,294.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,294.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,441.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,294.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,294.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,441.9,
XR ABDOMEN KUB,4500001,CDM,320,RC,,,outpatient,,,134.75,67.38,,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.17,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,123.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.28,
XR ABDOMEN FLAT/UPRT,4500002,CDM,320,RC,,,outpatient,,,197.25,98.63,,191.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,177.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,177.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,134.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,159.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,130.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,159.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,181.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,187.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,191.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,128.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,177.53,
Serial radiologic examition of the abdomen,4500003,CDM,320,RC,,,outpatient,,,235.75,117.88,,228.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,212.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,212.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,160.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,190.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,156.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,190.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,216.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,223.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,228.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,153.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,212.18,
XR AC JOINTS BILAT,4500004,CDM,320,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.76,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
Radiologic examition of the ankle with 2 views,4500005,CDM,320,RC,,,outpatient,,,270.25,135.13,,262.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.17,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,243.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,243.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,184.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,218.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,239.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,179.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,218.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,248.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,256.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,262.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,175.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,243.23,
XR BA SWALLOW MOD,4500006,CDM,320,RC,,,outpatient,,,428.5,214.25,,415.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,257.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,385.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,385.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,257.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,311.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,292.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,257.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,345.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,345.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,379.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,284.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,347.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,394.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,407.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,415.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,278.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,257.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,257.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,257.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,385.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,257.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,257.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,385.65,
XR BARIUM ENEMA W/AIR,4500007,CDM,320,RC,,,outpatient,,,899,449.5,,872.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,539.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,809.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,809.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,539.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,654.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,613.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,539.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,725.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,725.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,796.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,596.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,728.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,827.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,854.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,872.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,584.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,539.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,809.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,539.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,539.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,809.1,
XR BA SWAL ESOPH,4500008,CDM,320,RC,,,outpatient,,,408,204,,395.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,244.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.9,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,367.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,367.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,244.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,296.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,278.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,244.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,329.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,329.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,361.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,270.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,330.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,375.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,387.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,395.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,265.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,244.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,244.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,244.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,367.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,244.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,244.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,367.2,
XR ABDOMEN W DECUB,4500009,CDM,320,RC,,,outpatient,,,197.25,98.63,,191.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,177.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,177.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,134.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,159.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,130.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,159.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,181.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,187.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,191.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,128.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,177.53,
"2 views, front and back",4500011,CDM,324,RC,,,outpatient,,,164.25,82.13,,159.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,147.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,147.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,112.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,145.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,108.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,133.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,151.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,156.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,159.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,147.83,
Single view,4500012,CDM,320,RC,,,outpatient,,,126.5,63.25,,122.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.18,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,113.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,86.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,75.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,83.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,102.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,116.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,120.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,122.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,75.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,75.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,113.85,
XR CHOLANGIOGRAM SURG,4500015,CDM,320,RC,,,outpatient,,,477,238.5,,462.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,286.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.67,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,429.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,429.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,286.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,347.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,325.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,286.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,385.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,385.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,422.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,316.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,386.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,438.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,453.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,462.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,310.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,286.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,286.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,286.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,429.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,286.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,286.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,429.3,
XR CYSTOGRAM COMP,4500017,CDM,320,RC,,,outpatient,,,361,180.5,,350.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,216.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,324.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,324.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,216.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,246.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,216.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,291.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,291.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,319.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,239.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,292.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,332.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,342.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,350.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,234.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,216.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,216.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,216.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,324.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,216.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,216.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,324.9,
XR CYSTOGRAM VOID,4500018,CDM,320,RC,,,outpatient,,,442,221,,428.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,265.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,397.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,397.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,265.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,321.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,301.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,265.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,356.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,356.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,391.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,293.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,358.02,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,406.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,419.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,428.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,287.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,265.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,265.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,265.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,397.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,265.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,265.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,397.8,
XR FACIAL BONES MIN 3V,4500020,CDM,320,RC,,,outpatient,,,214.5,107.25,,208.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,193.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,193.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,146.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,173.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,190.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,142.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,173.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,197.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,203.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,208.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,193.05,
Radiologic examition of the finger(s),4500022,CDM,320,RC,,,outpatient,,,134.75,67.38,,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,123.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.28,
"Flouroscopy, or x-ray ""movie"" that takes less than an hour",4500023,CDM,320,RC,,,outpatient,,,430.75,215.38,,417.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,258.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,387.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,387.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,258.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,293.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,258.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,347.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,347.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,381.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,285.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,348.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,396.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,409.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,417.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,279.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,258.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,258.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,258.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,387.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,258.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,258.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,387.68,
XR FACIAL BONES <3V,4500026,CDM,320,RC,,,outpatient,,,158.25,79.13,,153.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.02,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,142.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,108.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,140.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,128.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,145.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,150.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,153.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,94.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,142.43,
XR IAM'S,4500032,CDM,320,RC,,,outpatient,,,233.75,116.88,,226.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,210.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,207.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,154.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,215.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,222.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,151.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,140.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.38,
XR MASTOIDS > 3V BILAT,4500035,CDM,320,RC,,,outpatient,,,522,261,,506.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,313.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,469.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,469.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,379.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,356.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,313.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,421.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,462.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,346.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,422.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,480.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,495.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,506.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,339.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,313.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,469.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,313.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,469.8,
Radiologic examition of the knee with 1 or 2 views,4500036,CDM,320,RC,,,outpatient,,,286,143,,277.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,171.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,257.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,257.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,171.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,195.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,171.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,230.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,230.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,253.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,189.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,231.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,263.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,271.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,277.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,185.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,171.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,257.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,171.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,171.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,257.4,
XR MANDIBLE MIN 4V,4500037,CDM,320,RC,,,outpatient,,,192.75,96.38,,186.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,115.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,173.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,173.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,131.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,115.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,170.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,127.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,156.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,177.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,183.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,186.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,125.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,115.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,115.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,173.48,
XR SAL BONES MIN 3V,4500039,CDM,320,RC,,,outpatient,,,155,77.5,,150.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,139.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,105.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,137.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,102.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,125.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,142.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,147.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,150.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,139.5,
Radiologic examition of the pelvis,4500044,CDM,320,RC,,,outpatient,,,136,68,,131.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.02,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,122.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,122.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,92.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,109.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,90.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,110.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,125.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,129.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,131.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,122.4,
XR PELVIS AND BILAT HIPS 3 OR 4 VIEWS,4500045,CDM,320,RC,,,outpatient,,,245.25,122.63,,237.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,147.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.15,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,220.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,220.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,147.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,167.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,147.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,197.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,217.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,162.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,198.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,225.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,232.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,237.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,159.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,147.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,220.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,147.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,147.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,220.73,
XR PELVIS AND BILAT HIPS 2V,4500046,CDM,320,RC,,,outpatient,,,197.25,98.63,,191.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.76,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,177.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,177.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,134.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,159.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,130.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,159.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,181.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,187.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,191.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,128.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,177.53,
XR RIBS BILAT W/PA CXR >4V,4500049,CDM,320,RC,,,outpatient,,,259.5,129.75,,251.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,233.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,233.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,177.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,209.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,229.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,172.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,210.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,238.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,246.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,251.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,233.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,233.55,
XR SACROILIAC JOINTS >= 3V,4500051,CDM,320,RC,,,outpatient,,,176,88,,170.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,116.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,142.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,161.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,170.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,158.4,
XR SACRUM AND COCCYX 2V,4500052,CDM,320,RC,,,outpatient,,,153.25,76.63,,148.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,137.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,104.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,101.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,124.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,140.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,145.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,148.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,137.93,
XR HYSTEROSALPINGOGRAPHY,4500053,CDM,320,RC,,,outpatient,,,474.75,237.38,,460.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,284.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.86,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,427.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,427.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,284.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,345.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,324.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,284.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,383.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,383.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,420.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,314.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,384.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,436.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,451.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,460.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,308.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,284.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,284.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,284.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,427.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,284.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,284.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,427.28,
XR SCAPULA BILAT,4500054,CDM,320,RC,,,outpatient,,,286,143,,277.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,171.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,257.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,257.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,171.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,195.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,171.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,230.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,230.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,253.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,189.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,231.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,263.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,271.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,277.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,185.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,171.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,257.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,171.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,171.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,257.4,
XR SCOLIOSIS SERIES 1V,4500055,CDM,320,RC,,,outpatient,,,224.75,112.38,,218.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,153.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,181.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,199.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,182.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,206.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,213.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,218.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,134.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,202.28,
XR SELLA TURCICA,4500056,CDM,320,RC,,,outpatient,,,139.5,69.75,,135.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,113,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,128.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,135.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,125.55,
Radiologic examition of the shoulder,4500057,CDM,320,RC,,,outpatient,,,305,152.5,,295.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,183,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.67,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,274.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,274.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,183,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,208.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,183,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,246.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,246.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,270.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,202.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,247.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,280.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,289.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,295.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,198.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,183,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,274.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,183,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,183,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,274.5,
XR SINUSES 3V,4500058,CDM,320,RC,,,outpatient,,,203.25,101.63,,197.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,182.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,138.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,164.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,180.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,134.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,164.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,186.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,193.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,197.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,132.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,182.93,
XR SKELETAL SURVEY ADULT,4500059,CDM,320,RC,,,outpatient,,,335,167.5,,324.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,201,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,301.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,301.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,201,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,228.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,201,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,270.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,270.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,296.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,222.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,271.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,308.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,318.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,324.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,217.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,201,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,301.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,201,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,201,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,301.5,
XR SKELETAL SURVEY/PED,4500060,CDM,320,RC,,,outpatient,,,423,211.5,,410.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,253.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.65,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,380.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,380.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,253.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,307.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,288.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,253.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,341.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,341.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,374.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,280.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,342.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,389.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,401.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,410.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,274.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,253.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,253.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,253.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,380.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,253.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,253.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,380.7,
XR SKULL COMPLETE >= 4V,4500061,CDM,320,RC,,,outpatient,,,248.5,124.25,,241.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,149.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,223.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,223.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,169.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,149.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,220.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,164.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,201.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,228.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,236.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,241.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,161.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,149.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,149.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,223.65,
XR SKULL AP/LAT < 4V,4500062,CDM,320,RC,,,outpatient,,,179.25,89.63,,173.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,161.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,161.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,122.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,144.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,158.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,118.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,145.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,164.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,170.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,173.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,116.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,107.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,161.33,
XR SMALL BOWEL SERIES,4500063,CDM,320,RC,,,outpatient,,,464,232,,450.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,278.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.23,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,417.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,417.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,278.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,337.61,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,316.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,278.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,374.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,374.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,411.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,307.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,375.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,426.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,440.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,450.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,301.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,278.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,278.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,278.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,417.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,278.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,278.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,417.6,
XR NECK/SOFT TISSUE,4500064,CDM,320,RC,,,outpatient,,,132.5,66.25,,128.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,119.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,90.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,117.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,107.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,121.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,125.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,128.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,119.25,
"Radiologic examition of the neck/spine, 4-5 views",4500065,CDM,320,RC,,,outpatient,,,257.5,128.75,,249.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,154.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.55,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,231.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,231.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,154.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.36,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,175.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,154.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,207.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,228.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,170.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,208.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,236.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,244.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,249.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,167.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,154.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,231.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,154.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,154.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,231.75,
"Radiologic examition of the neck/spine, 2-3 views",4500066,CDM,320,RC,,,outpatient,,,181.25,90.63,,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,108.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.13,
XR SPINE COMP 2/3V,4500068,CDM,320,RC,,,outpatient,,,335,167.5,,324.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,201,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.83,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,301.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,301.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,201,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,228.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,201,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,270.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,270.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,296.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,222.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,271.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,308.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,318.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,324.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,217.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,201,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,301.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,201,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,201,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,301.5,
"Radiologic examition of the middle spine, 2 views",4500069,CDM,320,RC,,,outpatient,,,173,86.5,,167.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.17,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,155.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,118.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,153.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,140.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,159.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,164.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,167.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,103.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,155.7,
"X-ray of lower and sacral spine, minimum of 4 views",4500070,CDM,320,RC,,,outpatient,,,265.75,132.88,,257.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,159.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.15,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,239.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,239.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.36,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,181.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,159.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,214.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,235.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,176.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,215.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,244.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,252.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,257.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,172.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,159.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,239.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,159.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,239.18,
X-ray of the lower spine 2-3 views,4500071,CDM,320,RC,,,outpatient,,,190.75,95.38,,185.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,171.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,171.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,130.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,153.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,153.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,169.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,126.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,154.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,175.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,181.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,185.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,123.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,171.68,
XR STERCLAVICULAR JOINT 3V,4500072,CDM,320,RC,,,outpatient,,,188.75,94.38,,183.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.86,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,169.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,169.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,128.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,113.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,167.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,125.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,152.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,173.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,179.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,183.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,122.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,113.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,113.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,169.88,
XR STERNUM MIN 2V,4500073,CDM,320,RC,,,outpatient,,,171.75,85.88,,166.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.67,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,154.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,154.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,117.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,138.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,113.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,139.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,158.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,163.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,166.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,103.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,154.58,
Radiologic examition of the lower leg,4500075,CDM,320,RC,,,outpatient,,,278.5,139.25,,270.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.97,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,250.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,190.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,224.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,246.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,184.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,225.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,256.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,264.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,270.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,181.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,250.65,
Radiologic examition of the toe(s),4500077,CDM,320,RC,,,outpatient,,,130.25,65.13,,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,88.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,105.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,119.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,123.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117.23,
XR UGI W AIR CONT W KUB,4500079,CDM,320,RC,,,outpatient,,,623.25,311.63,,604.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,373.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,560.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,560.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,373.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,453.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,425.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,373.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,503.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,503.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,552.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,413.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,504.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,573.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,592.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,604.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,405.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,373.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,373.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,373.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,560.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,373.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,373.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,560.93,
A diagnostic procedure that allows a provider to see the organs and other structures in the abdomen,4500085,CDM,402,RC,,,outpatient,,,491,245.5,,476.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,294.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,441.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,441.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,294.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,357.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,335.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,294.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,396.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,396.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,435.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,325.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,397.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,451.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,466.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,476.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,319.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,294.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,294.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,294.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,441.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,294.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,294.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,441.9,
Ultrasound of abdomen with all areas scanned,4500086,CDM,402,RC,,,outpatient,,,655.5,327.75,,635.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,393.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.58,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,589.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,589.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,393.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,476.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,447.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,393.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,529.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,529.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,580.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,434.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,530.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,603.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,622.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,635.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,426.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,393.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,393.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,393.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,393.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,393.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,589.95,
US AORTA LTD,4500087,CDM,921,RC,,,outpatient,,,494.25,247.13,,479.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,296.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,444.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,444.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,444.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,296.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,359.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,337.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,296.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,398.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,398.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,437.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,327.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,400.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,454.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,469.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,479.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,321.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,296.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,296.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,296.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,444.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,296.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,296.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,444.83,
Abdomil ultrasound of pregnt uterus (greater or equal to 14 weeks 0 days) single or first fetus,4500088,CDM,402,RC,,,outpatient,,,707.75,353.88,,686.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,636.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,636.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,514.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,483.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,571.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,571.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,627.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,469.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,573.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,651.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,672.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,686.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,460.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,636.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,424.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,636.98,
Ultrasound of fetus with limited views,4500089,CDM,402,RC,,,outpatient,,,450.75,225.38,,437.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,270.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.32,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,405.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,405.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,270.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,327.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,307.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,270.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,363.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,363.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,399.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,298.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,365.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,414.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,428.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,437.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,292.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,270.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,270.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,270.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,405.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,270.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,270.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,405.68,
Ultrasound of bladder to measure urine capacity,4500092,CDM,761,RC,,,outpatient,,,130.25,65.13,,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,88.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,105.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,119.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,123.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117.23,
Complete ultrasound of the pelvis,4500093,CDM,402,RC,,,outpatient,,,565.25,282.63,,548.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,339.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.79,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,508.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,508.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,339.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,411.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,385.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,339.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,456.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,456.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,500.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,374.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,457.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,520.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,536.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,548.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,367.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,339.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,339.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,339.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,508.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,339.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,339.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,508.73,
Ultrasound of back wall of the abdomen with limited areas viewed,4500094,CDM,402,RC,,,outpatient,,,494.25,247.13,,479.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,296.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,444.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,444.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,296.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,359.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,337.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,296.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,398.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,398.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,437.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,327.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,400.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,454.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,469.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,479.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,321.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,296.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,296.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,296.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,444.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,296.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,296.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,444.83,
XR WATERS VIEW <3 VIEWS,4500099,CDM,320,RC,,,outpatient,,,155,77.5,,150.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,139.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,105.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,137.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,102.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,125.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,142.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,147.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,150.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,93,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,139.5,
XR ZYGOMATIC ARCHES 3+V,4500101,CDM,320,RC,,,outpatient,,,214.5,107.25,,208.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,193.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,193.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,146.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,173.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,190.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,142.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,173.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,197.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,203.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,208.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,193.05,
XR FEMUR 1V RT,4500104,CDM,320,RC,,,outpatient,,,136.75,68.38,,132.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,90.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,110.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,125.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,129.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,132.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.08,
Limited ultrasound of the pelvis,4500106,CDM,402,RC,,,outpatient,,,483,241.5,,468.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,289.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,434.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,434.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,289.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,351.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,329.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,289.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,389.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,389.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,427.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,320.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,391.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,444.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,458.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,468.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,313.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,289.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,289.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,289.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,434.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,289.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,289.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,434.7,
XR FEMUR 1V LEFT,4500107,CDM,320,RC,,,outpatient,,,136.75,68.38,,132.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,90.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,110.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,125.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,129.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,132.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.08,
Ultrasound of head and neck,4500112,CDM,402,RC,,,outpatient,,,513.25,256.63,,497.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.78,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,461.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,461.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,373.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,350.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,414.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,414.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,454.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,340.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,415.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,472.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,487.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,497.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,333.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,461.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,461.93,
US UPPER MID ABDOMEN SOFT TISSUE,4500116,CDM,402,RC,,,outpatient,,,277.5,138.75,,269.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,166.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,249.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,249.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,189.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,166.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,224,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,245.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,183.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,224.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,255.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,263.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,269.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,180.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,166.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,249.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,166.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,249.75,
US ECHO W/O CONTRAST TRANSTHORACIC LTD,4500120,CDM,483,RC,,,outpatient,,,563.75,281.88,,546.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,338.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,507.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,507.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,507.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,338.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,410.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,384.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,338.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,455.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,455.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,499.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,373.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,456.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,518.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,535.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,546.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,366.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,338.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,338.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,338.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,507.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,338.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,338.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,507.38,
Study of vessels on both sides of the head and neck,4500121,CDM,921,RC,,,outpatient,,,1168.75,584.38,,1133.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,701.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1051.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,1051.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,1051.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,701.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,850.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,797.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,701.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,943.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,943.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1035.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,774.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,946.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1075.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,1110.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,1133.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,759.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,701.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,701.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,701.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1051.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,701.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,701.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1051.88,
Complete bilateral study of the extremities,4500123,CDM,921,RC,,,outpatient,,,1138,569,,1103.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,682.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1024.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,1024.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,1024.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,682.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,828.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,776.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,682.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,918.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,918.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1008.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,754.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,921.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1046.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,1081.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,1103.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,739.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,682.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,682.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,682.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1024.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,682.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,682.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1024.2,
US ART DOP LEGS BILAT,4500125,CDM,921,RC,,,outpatient,,,1557,778.5,,1510.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,934.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1401.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1401.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1401.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,934.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1132.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1062.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,934.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1256.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1256.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1379.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1032.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1261.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1432.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,1479.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,1510.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1012.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,934.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,934.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,934.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1401.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,934.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,934.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1401.3,
"Ultrasound examition of heart including color-depicted blood flow rate, direction, and valve function",4500126,CDM,483,RC,,,outpatient,,,1754,877,,1701.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,1052.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1578.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,1578.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,1578.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,1052.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1276.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1197.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1052.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1415.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1415.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1554.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1162.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1420.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1613.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,1666.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,1701.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,1140.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,1052.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1052.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1052.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1578.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,1052.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1052.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1578.6,
US DUP COMP AORTA ILIAC,4500128,CDM,921,RC,,,outpatient,,,1178,589,,1142.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,706.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1060.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,1060.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,1060.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,706.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,857.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,803.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,706.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,950.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,950.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1043.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,781.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,954.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1083.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,1119.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,1142.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,765.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,706.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,706.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,706.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1060.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,706.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,706.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1060.2,
US ART DOP ARMS BILAT,4500130,CDM,921,RC,,,outpatient,,,1242.5,621.25,,1205.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,745.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1118.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1118.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1118.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,745.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,904.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,848.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,745.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1002.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1002.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1100.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,823.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1006.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1143.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,1180.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,1205.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,807.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,745.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,745.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,745.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1118.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,745.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,745.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1118.25,
CT CX SPINE W/O CONT,4500135,CDM,352,RC,,,outpatient,,,1455.5,727.75,,1411.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,873.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1309.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,1309.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,873.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1059.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,993.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,873.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1174.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1174.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1289.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,965,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1178.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1339.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,1382.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,1411.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,946.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,873.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,873.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,873.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1309.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,873.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,873.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1309.95,
CT HEAD W CONTRAST,4500140,CDM,351,RC,,,outpatient,,,1431.25,715.63,,1388.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,858.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1288.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,1288.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,858.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1041.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,976.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,858.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1155.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1155.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1268.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,948.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1159.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1316.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,1359.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,1388.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,930.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,858.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,858.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,858.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1288.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,858.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,858.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1288.13,
CT scan head or brain without dye,4500141,CDM,351,RC,,,outpatient,,,1125.75,562.88,,1091.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,675.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1013.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1013.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,675.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,819.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,768.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,675.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,908.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,908.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,997.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,746.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,911.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1035.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,1069.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,1091.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,731.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,675.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,675.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,675.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1013.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,675.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,675.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1013.18,
CT HEAD W/WO CONTRAST,4500142,CDM,351,RC,,,outpatient,,,1737,868.5,,1684.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,1042.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1563.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1563.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1042.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1263.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1185.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1042.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1402.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1402.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1539.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1151.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1406.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1598.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,1650.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,1684.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,1129.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,1042.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1042.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1042.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1563.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1042.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1042.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1563.3,
CT LOW EXT W/CONT RT,4500143,CDM,352,RC,,,outpatient,,,1598.25,799.13,,1550.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,958.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.57,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1438.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,1438.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,958.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1162.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1090.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,958.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1290.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1290.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1416.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1059.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1294.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1470.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,1518.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,1550.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,1038.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,958.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,958.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,958.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1438.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,958.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,958.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1438.43,
CT scan of leg without dye,4500144,CDM,352,RC,,,outpatient,,,1335.75,667.88,,1295.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1202.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1202.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,971.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,911.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1078.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1078.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1183.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,885.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1081.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1228.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,1268.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,1295.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,868.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1202.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1202.18,
CT LOW EXT W/WO CONT RT,4500145,CDM,352,RC,,,outpatient,,,2024.25,1012.13,,1963.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,1214.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1821.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,1821.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,1214.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1472.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1381.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1214.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1633.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1633.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1793.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1342.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1639.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1862.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,1923.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,1963.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,1315.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,1214.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1214.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1214.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1821.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,1214.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1214.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1821.83,
CT scan of lower spine without dye,4500147,CDM,352,RC,,,outpatient,,,1452.25,726.13,,1408.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,871.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1307.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,1307.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,871.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1056.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,991.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,871.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1172.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1172.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1286.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,962.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1176.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1336.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,1379.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,1408.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,943.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,871.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,871.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,871.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1307.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,871.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,871.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1307.03,
CT MAXOFACIAL W CONT,4500148,CDM,351,RC,,,outpatient,,,1637,818.5,,1587.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,982.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.83,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1473.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1473.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,982.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1191.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1117.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,982.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1321.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1321.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1450.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1085.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1325.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1506.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,1555.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,1587.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,1064.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,982.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,982.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,982.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1473.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,982.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,982.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1473.3,
CT Scan of the face and jaw without dye,4500149,CDM,351,RC,,,outpatient,,,1358.5,679.25,,1317.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,815.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1222.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,1222.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,815.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,988.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,927.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,815.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1096.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1096.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1203.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,900.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1100.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1249.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,1290.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,1317.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,883.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,815.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,815.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,815.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1222.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,815.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,815.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1222.65,
CT MAXOFACIAL W WO CONT,4500150,CDM,351,RC,,,outpatient,,,1997.25,998.63,,1937.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,1198.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,179.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1797.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,1797.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,1198.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1453.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1363.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1198.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1612.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1612.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1769.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1324.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1617.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1837.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,1897.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,1937.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,1298.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,1198.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1198.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1198.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1797.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,1198.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1198.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1797.53,
CT scan of neck with dye,4500151,CDM,351,RC,,,outpatient,,,1624.75,812.38,,1576.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,974.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,179.35,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1462.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1462.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,974.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1182.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1108.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,974.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1311.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1311.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1439.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1077.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1316.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1494.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,1543.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,1576.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,1056.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,974.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,974.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,974.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1462.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,974.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,974.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1462.28,
CT SOFT TISSUE NECK W/O CONT,4500152,CDM,351,RC,,,outpatient,,,1362,681,,1321.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,817.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1225.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1225.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,817.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,990.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,929.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,817.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1099.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1099.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1206.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,903.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1103.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1253.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,1293.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,1321.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,885.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,817.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,817.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,817.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1225.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,817.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,817.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1225.8,
CT SOFT TISS NECK W/WO,4500153,CDM,351,RC,,,outpatient,,,1969.25,984.63,,1910.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,1181.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.75,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1772.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1772.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1181.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1432.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1344.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1181.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1589.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1589.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1744.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1305.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1595.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1811.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,1870.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,1910.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,1280.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,1181.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1181.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1181.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1772.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1181.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1181.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1772.33,
CT ORBIT W/CONT,4500154,CDM,351,RC,,,outpatient,,,1805.75,902.88,,1751.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,1083.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1625.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1625.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1083.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1313.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1232.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1083.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1457.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1457.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1600.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1197.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1462.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1661.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,1715.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,1751.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,1173.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,1083.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1083.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1083.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1625.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1083.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1083.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1625.18,
CT ORBIT W/O CONTRAST,4500155,CDM,351,RC,,,outpatient,,,1547.5,773.75,,1501.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,928.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1392.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,1392.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,928.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1125.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1056.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,928.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1249.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1249.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1371.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1025.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1253.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1423.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,1470.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,1501.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,1005.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,928.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,928.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,928.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1392.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,928.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,928.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1392.75,
CT ORBIT W/WO CONT,4500156,CDM,351,RC,,,outpatient,,,2098.25,1049.13,,2035.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,1258.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1888.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,1888.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,1258.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1526.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1432.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1258.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1693.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1693.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1859.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1391.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1699.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1930.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,1993.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,2035.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,1363.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,1258.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1258.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1258.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1888.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,1258.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1258.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1888.43,
CT of pelvis without dye,4500158,CDM,352,RC,,,outpatient,,,1401.5,700.75,,1359.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,840.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.35,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1261.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,1261.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,840.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1019.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,956.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,840.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1131.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1131.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1241.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,929.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1135.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1289.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,1331.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,1359.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,910.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,840.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,840.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,840.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1261.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,840.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,840.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1261.35,
CT DOR SPINE W/O CONT,4500162,CDM,350,RC,,,outpatient,,,1453.75,726.88,,1410.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,872.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1308.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,1308.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,872.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1057.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,992.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,872.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1173.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1173.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1288.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,963.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1177.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1337.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,1381.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,1410.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,944.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,872.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,872.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,872.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1308.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,872.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,872.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1308.38,
CT UP EX W/O CONT RT,4500164,CDM,352,RC,,,outpatient,,,1335.75,667.88,,1295.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1202.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1202.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,971.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,911.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1078.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1078.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1183.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,885.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1081.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1228.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,1268.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,1295.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,868.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1202.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1202.18,
Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries,4500169,CDM,921,RC,,,outpatient,,,614.75,307.38,,596.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,368.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,553.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,553.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,553.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,368.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,447.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,419.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,368.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,496.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,496.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,544.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,407.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,497.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,565.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,584.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,596.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,399.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,368.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,368.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,368.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,553.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,368.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,368.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,553.28,
Radiologic examition of the toe(s),4500177,CDM,320,RC,,,outpatient,,,130.25,65.13,,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,88.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,105.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,119.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,123.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117.23,
Radiologic examition of the toe(s),4500178,CDM,320,RC,,,outpatient,,,130.25,65.13,,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,88.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,105.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,119.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,123.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117.23,
Radiologic examition of the toe(s),4500179,CDM,320,RC,,,outpatient,,,130.25,65.13,,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,88.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,105.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,119.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,123.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117.23,
Radiologic examition of the toe(s),4500180,CDM,320,RC,,,outpatient,,,130.25,65.13,,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,88.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,105.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,119.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,123.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117.23,
Radiologic examition of the toe(s),4500181,CDM,320,RC,,,outpatient,,,130.25,65.13,,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,88.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,105.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,119.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,123.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117.23,
Radiologic examition of the toe(s),4500182,CDM,320,RC,,,outpatient,,,130.25,65.13,,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,88.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,105.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,119.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,123.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117.23,
Radiologic examition of the toe(s),4500183,CDM,320,RC,,,outpatient,,,130.25,65.13,,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,88.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,105.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,119.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,123.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117.23,
Radiologic examition of the toe(s),4500184,CDM,320,RC,,,outpatient,,,130.25,65.13,,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,88.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,105.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,119.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,123.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117.23,
Radiologic examition of the toe(s),4500185,CDM,320,RC,,,outpatient,,,130.25,65.13,,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,88.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,105.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,119.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,123.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117.23,
XR SCOLIOSIS SERIES 4 OR 5 V,4500188,CDM,320,RC,,,outpatient,,,248.5,124.25,,241.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,149.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,223.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,223.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,169.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,149.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,220.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,164.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,201.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,228.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,236.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,241.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,161.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,149.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,149.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,223.65,
XR SCOLIOSIS SERIES 2 OR 3 V,4500189,CDM,320,RC,,,outpatient,,,237,118.5,,229.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.83,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,213.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,161.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,191.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,191.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,210.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,157.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,191.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,218.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,225.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,229.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,154.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,213.3,
XR SPINE 1 VIEW,4500212,CDM,320,RC,,,outpatient,,,119.5,59.75,,115.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,107.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,81.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,96.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,109.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,113.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,115.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,71.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,107.55,
XR SPINE CERV 6 OR MORE VIEWS,4500214,CDM,320,RC,,,outpatient,,,323.25,161.63,,313.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,193.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,290.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,290.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,193.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,220.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,193.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,260.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,260.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,286.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,214.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,261.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,297.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,307.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,313.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,210.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,193.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,290.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,193.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,193.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,290.93,
"Radiologic examition of the middle spine, 3 views",4500216,CDM,320,RC,,,outpatient,,,194,97,,188.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,116.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,174.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,116.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,132.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,116.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,171.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,128.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,157.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,178.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,184.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,188.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,126.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,116.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,116.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,116.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,174.6,
Ultrasound of the scrotum,4500218,CDM,402,RC,,,outpatient,,,558,279,,541.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,334.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.94,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,502.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,502.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,334.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,406,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,380.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,334.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,450.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,450.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,494.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,369.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,451.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,513.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,530.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,541.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,362.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,334.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,334.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,334.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,502.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,334.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,334.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,502.2,
Radiologic examition of the finger(s),4500223,CDM,320,RC,,,outpatient,,,134.75,67.38,,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,123.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.28,
Radiologic examition of the finger(s),4500224,CDM,320,RC,,,outpatient,,,134.75,67.38,,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,123.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.28,
Radiologic examition of the finger(s),4500225,CDM,320,RC,,,outpatient,,,134.75,67.38,,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,123.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.28,
Radiologic examition of the finger(s),4500226,CDM,320,RC,,,outpatient,,,134.75,67.38,,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,123.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.28,
Radiologic examition of the finger(s),4500227,CDM,320,RC,,,outpatient,,,134.75,67.38,,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,123.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.28,
Radiologic examition of the finger(s),4500228,CDM,320,RC,,,outpatient,,,134.75,67.38,,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,123.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.28,
Radiologic examition of the finger(s),4500229,CDM,320,RC,,,outpatient,,,134.75,67.38,,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,123.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.28,
US AORTA COMPLETE,4500230,CDM,921,RC,,,outpatient,,,984.75,492.38,,955.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,590.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,886.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,886.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,886.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,590.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,716.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,672.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,590.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,794.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,794.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,872.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,652.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,797.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,905.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,935.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,955.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,640.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,590.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,590.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,590.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,886.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,590.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,590.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,886.28,
Ultrasound of back wall of the abdomen with all areas viewed,4500232,CDM,402,RC,,,outpatient,,,631,315.5,,612.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,378.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,567.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,567.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,378.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,459.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,430.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,378.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,509.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,509.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,559.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,418.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,511.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,580.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,599.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,612.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,410.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,378.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,378.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,378.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,567.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,378.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,378.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,567.9,
Radiologic examition of the finger(s),4500233,CDM,320,RC,,,outpatient,,,134.75,67.38,,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,123.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.28,
US COMP P SCAN >14 AG,4500236,CDM,402,RC,,,outpatient,,,496.25,248.13,,481.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,446.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,446.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,361.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,338.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,400.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,439.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,329.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,401.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,456.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,471.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,481.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,322.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,446.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,446.63,
Radiologic examition of the finger(s),4500237,CDM,320,RC,,,outpatient,,,134.75,67.38,,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,123.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.28,
Scan to measure bone mineral density (BMD) at the spine and hip,4500238,CDM,320,RC,,,outpatient,,,472,236,,457.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,283.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.16,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,424.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,424.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,283.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,343.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,322.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,283.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,381,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,418.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,312.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,382.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,434.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,448.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,457.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,306.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,283.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,283.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,283.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,424.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,283.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,283.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,424.8,
XR RIBS BIL 3V,4500240,CDM,320,RC,,,outpatient,,,211.5,105.75,,205.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,126.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,190.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,190.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,126.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,153.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,144.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,126.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,170.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,187.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,140.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,171.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,194.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,200.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,205.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,137.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,126.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,126.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,126.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,190.35,
US SOFT TISSUE MIDSECTION,4500246,CDM,402,RC,,,outpatient,,,332.25,166.13,,322.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,199.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,299.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,299.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,199.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,241.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,226.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,199.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,268.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,268.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,294.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,220.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,269.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,305.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,315.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,322.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,215.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,199.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,199.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,199.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,299.03,
Transvagil ultrasound of uterus,4500248,CDM,402,RC,,,outpatient,,,496.25,248.13,,481.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,446.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,446.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,361.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,338.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,400.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,439.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,329.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,401.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,456.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,471.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,481.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,322.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,446.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,446.63,
US ADDL GEST AT SURVEY,4500250,CDM,402,RC,,,outpatient,,,712.25,356.13,,690.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,427.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,641.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,641.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,427.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,518.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,486.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,427.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,574.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,574.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,631.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,472.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,576.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,655.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,676.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,690.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,462.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,427.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,427.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,427.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,641.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,427.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,427.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,641.03,
Ultrasound of single fetus,4500252,CDM,402,RC,,,outpatient,,,1094.25,547.13,,1061.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,656.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.65,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,984.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,984.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,656.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,796.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,746.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,656.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,883.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,883.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,969.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,725.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,886.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1006.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,1039.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,1061.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,711.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,656.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,656.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,656.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,984.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,656.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,656.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,984.83,
US ADDL GEST < 14 WKS,4500254,CDM,402,RC,,,outpatient,,,385.25,192.63,,373.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,231.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.3,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,346.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,346.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,231.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,280.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,262.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,231.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,310.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,310.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,341.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,255.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,312.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,354.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,365.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,373.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,250.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,231.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,231.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,231.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,346.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,231.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,231.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,346.73,
Abdomil ultrasound of pregnt uterus (less than 14 weeks) single or first fetus,4500256,CDM,402,RC,,,outpatient,,,607.25,303.63,,589.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,364.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.68,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,546.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,546.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,364.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,441.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,414.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,364.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,490.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,490.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,538.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,402.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,491.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,558.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,576.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,589.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,394.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,364.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,364.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,364.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,546.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,364.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,364.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,546.53,
US CHEST WALL,4500258,CDM,402,RC,,,outpatient,,,419.25,209.63,,406.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,251.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,377.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,377.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,251.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,305.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,286.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,251.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,338.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,338.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,371.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,277.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,339.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,385.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,398.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,406.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,272.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,251.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,377.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,251.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,251.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,377.33,
CT ANG LOW EXT W WO CONT,4500259,CDM,352,RC,,,outpatient,,,2647.5,1323.75,,2568.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,1588.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.25,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2382.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,2382.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,1588.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1926.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1806.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1588.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2137.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2137.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2345.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1755.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2144.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2435.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,2515.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,2568.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,1720.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,1588.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1588.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1588.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2382.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,1588.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1588.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2382.75,
CTA ABD W AND/OR WO,4500261,CDM,352,RC,,,outpatient,,,2737.75,1368.88,,2655.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,1642.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,255.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2463.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,2463.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,1642.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1991.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1868.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1642.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2209.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2209.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2425.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1815.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2217.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2518.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,2600.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,2655.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,1779.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,1642.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1642.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1642.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2463.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,1642.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1642.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2463.98,
"Fine needle aspiration biopsy, including ultrasound guidance; first lesion",4500268,CDM,320,RC,,,outpatient,,,742.5,371.25,,720.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,445.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,668.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,668.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,445.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,540.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,506.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,445.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,599.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,599.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,657.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,492.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,601.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,683.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,705.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,720.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,482.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,445.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,445.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,445.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,668.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,445.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,445.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,668.25,
Transrectal ultrasound,4500270,CDM,402,RC,,,outpatient,,,556.25,278.13,,539.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,333.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,500.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,500.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,333.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,404.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,379.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,333.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,449.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,449.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,492.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,368.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,450.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,511.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,528.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,539.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,361.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,333.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,333.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,333.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,500.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,333.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,333.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,500.63,
"Fine needle aspiration biopsy, including ultrasound guidance; first lesion",4500271,CDM,402,RC,,,outpatient,,,1737.25,868.63,,1685.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,1042.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1563.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,1563.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,1042.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1264.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1185.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1042.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1402.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1402.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1539.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1151.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1407.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1598.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,1650.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,1685.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,1129.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,1042.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1042.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1042.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1563.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,1042.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1042.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1563.53,
XR UGI W/O KUB,4500273,CDM,320,RC,,,outpatient,,,512,256,,496.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,307.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.57,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,460.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,460.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,307.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,372.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,349.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,307.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,413.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,413.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,453.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,339.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,414.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,471.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,486.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,496.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,332.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,307.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,307.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,307.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,460.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,307.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,307.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,460.8,
XR UGI W KUB,4500274,CDM,320,RC,,,outpatient,,,538,269,,521.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.57,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,484.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,484.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,391.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,367.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,434.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,434.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,476.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,356.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,435.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,494.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,511.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,521.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,349.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,484.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,484.2,
CTA AORTA ILIOFEMORAL RU,4500276,CDM,352,RC,,,outpatient,,,3268.25,1634.13,,3170.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,1960.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,283.18,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2941.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,2941.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,1960.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2377.98,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2230.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1960.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2638.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2638.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2896,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2166.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2647.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3006.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,3104.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,3170.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,2124.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,1960.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1960.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1960.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2941.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,1960.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1960.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2941.43,
US GUID NEEDLE PLACEMENT,4500287,CDM,402,RC,,,outpatient,,,1737.25,868.63,,1685.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,1042.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.2,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1563.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,1563.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,1042.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1264.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1185.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1042.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1402.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1402.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1539.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1151.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1407.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1598.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,1650.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,1685.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,1129.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,1042.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1042.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1042.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1563.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,1042.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1042.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1563.53,
CT LOW DOSE LUNG SCREENING,4500297,CDM,352,RC,,,outpatient,,,171,85.5,,165.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,153.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,153.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,102.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,116.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,102.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,138.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,151.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,113.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,138.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,157.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,162.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,165.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,102.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,153.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,102.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,102.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,153.9,
US AAA SCREEN,4500389,CDM,402,RC,,,outpatient,,,655.5,327.75,,635.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,393.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.23,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,589.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,589.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,393.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,476.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,447.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,393.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,529.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,529.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,580.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,434.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,530.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,603.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,622.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,635.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,426.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,393.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,393.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,393.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,589.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,393.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,393.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,589.95,
"Radiologic examition, elbow; 2 views",4501019,CDM,320,RC,,,outpatient,,,136,68,,131.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.83,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,122.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,122.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,92.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,109.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,90.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,110.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,125.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,129.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,131.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,122.4,
XR FEMUR 2V LEFT,4501021,CDM,320,RC,,,outpatient,,,148.75,74.38,,144.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,133.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,131.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,136.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,133.88,
Radiologic examition of the forearm,4501025,CDM,320,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.77,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
Radiologic examition of the knee with 1 or 2 views,4501036,CDM,320,RC,,,outpatient,,,144,72,,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,116.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,136.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,129.6,
Single view,4501045,CDM,320,RC,,,outpatient,,,126.5,63.25,,122.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.18,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,113.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,86.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,75.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,83.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,102.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,116.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,120.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,122.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,75.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,75.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,113.85,
3 views,4501047,CDM,324,RC,,,outpatient,,,164.25,82.13,,159.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,147.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,147.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,112.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,145.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,108.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,133.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,151.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,156.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,159.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,147.83,
4 or more views,4501048,CDM,324,RC,,,outpatient,,,259.5,129.75,,251.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,233.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,233.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,177.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,209.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,229.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,172.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,210.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,238.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,246.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,251.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,233.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,233.55,
Radiologic examition of one side of the chest/ribs,4501050,CDM,320,RC,,,outpatient,,,197.25,98.63,,191.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,177.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,177.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,134.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,159.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,130.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,159.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,181.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,187.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,191.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,128.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,177.53,
XR SCAPULA RIGHT,4501054,CDM,320,RC,,,outpatient,,,144,72,,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,116.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,136.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,129.6,
Radiologic examition of the shoulder,4501057,CDM,320,RC,,,outpatient,,,153.25,76.63,,148.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.67,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,137.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,104.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,101.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,124.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,140.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,145.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,148.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,137.93,
XR RT HIP W PELVIS 2/3 V,4501067,CDM,320,RC,,,outpatient,,,313.5,156.75,,304.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,188.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.66,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,282.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,282.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,188.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,213.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,188.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,253.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,253.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,277.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,207.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,253.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,288.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,297.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,304.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,203.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,188.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,282.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,188.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,188.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,282.15,
Radiologic examition of the knee with 3 views,4501069,CDM,320,RC,,,outpatient,,,167.75,83.88,,162.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.66,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,150.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,111.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,154.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,159.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.98,
Radiologic examition of the knee with 4 or more views,4501071,CDM,320,RC,,,outpatient,,,190.75,95.38,,185.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,171.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,171.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,130.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,153.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,153.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,169.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,126.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,154.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,175.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,181.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,185.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,123.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,171.68,
Radiologic examition of the lower leg,4501075,CDM,320,RC,,,outpatient,,,139.5,69.75,,135.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.97,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,113,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,128.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,135.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,125.55,
Up to 3 views,4501083,CDM,320,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
Radiologic examition of the ankle with 2 views,4501105,CDM,320,RC,,,outpatient,,,136,68,,131.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.17,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,122.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,122.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,92.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,109.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,90.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,110.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,125.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,129.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,131.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,122.4,
Radiologic examition of the collar bone,4501116,CDM,320,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.67,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
One sided or limited bilateral study,4501124,CDM,921,RC,,,outpatient,,,796.25,398.13,,772.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,716.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,716.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,716.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,579.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,543.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,642.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,642.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,705.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,527.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,644.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,732.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,756.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,772.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,517.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,716.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,716.63,
X-ray of the hand with 3 or more views,4501127,CDM,320,RC,,,outpatient,,,153.25,76.63,,148.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.32,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,137.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,104.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,101.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,124.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,140.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,145.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,148.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,137.93,
Radiologic examition of the heel,4501128,CDM,320,RC,,,outpatient,,,132.5,66.25,,128.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,119.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,90.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,117.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,107.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,121.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,125.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,128.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,119.25,
"XR HIP, UNILAT W PELVIS 1V LT",4501129,CDM,320,RC,,,outpatient,,,301.5,150.75,,292.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,180.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,271.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,271.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,180.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,219.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,205.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,180.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,267.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,199.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,244.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,277.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,286.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,292.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,195.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,180.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,180.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,180.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,271.35,
XR HUMERUS 2V RIGHT,4501130,CDM,320,RC,,,outpatient,,,150.25,75.13,,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.57,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135.23,
CT scan of leg without dye,4501144,CDM,352,RC,,,outpatient,,,2671,1335.5,,2590.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,1602.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2403.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,2403.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,1602.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1943.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1822.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1602.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2156.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2156.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2366.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1770.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2163.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2457.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,2537.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,2590.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,1736.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,1602.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1602.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1602.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2403.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,1602.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1602.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2403.9,
CT UP EX W/CONT RT,4501163,CDM,352,RC,,,outpatient,,,1590.75,795.38,,1543.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,954.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195.17,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1431.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1431.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,954.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1157.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1085.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,954.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1284.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1284.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1409.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1054.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1288.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1463.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,1511.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,1543.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,1033.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,954.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,954.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,954.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1431.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,954.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,954.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1431.68,
CT UP EX W/W/O CONT RT,4501165,CDM,352,RC,,,outpatient,,,2006.5,1003.25,,1946.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,1203.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.23,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1805.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,1805.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,1203.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1459.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1369.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1203.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1619.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1619.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1777.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1330.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1625.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1845.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,1906.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,1946.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,1304.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,1203.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1203.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1203.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1805.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,1203.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1203.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1805.85,
XR FEMUR 2V RIGHT,4501201,CDM,320,RC,,,outpatient,,,148.75,74.38,,144.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,133.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,131.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,136.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,133.88,
"Radiologic examition, elbow; 3 or more views",4501203,CDM,320,RC,,,outpatient,,,167.75,83.88,,162.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.32,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,150.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,111.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,154.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,159.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.98,
3 or more views,4501204,CDM,320,RC,,,outpatient,,,139.5,69.75,,135.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,113,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,128.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,135.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,125.55,
X-ray of the hand with 2 views,4501205,CDM,320,RC,,,outpatient,,,136,68,,131.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.67,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,122.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,122.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,92.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,109.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,90.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,110.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,125.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,129.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,131.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,122.4,
Radiologic examition of the ankle with 3 views,4501207,CDM,320,RC,,,outpatient,,,153.25,76.63,,148.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.32,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,137.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,104.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,101.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,124.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,140.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,145.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,148.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,137.93,
Radiologic examition of the foot with 3 or more views,4501208,CDM,320,RC,,,outpatient,,,153.25,76.63,,148.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.52,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,137.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,104.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,101.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,124.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,140.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,145.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,148.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,137.93,
Radiologic examition of the collar bone,4501216,CDM,320,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.67,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
"Radiologic examition, foot; 2 views",4501224,CDM,320,RC,,,outpatient,,,134.75,67.38,,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,123.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.28,
XR RIBS UNIL RIGHT 2V,4501242,CDM,320,RC,,,outpatient,,,164.25,82.13,,159.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,147.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,147.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,112.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,145.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,108.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,133.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,151.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,156.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,159.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,147.83,
FLUORO GUIDANCE NEEDLE PLACEMENT,4501301,CDM,320,RC,,,outpatient,,,516.25,258.13,,500.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,309.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,464.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,464.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,309.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,375.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,352.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,309.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,416.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,416.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,457.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,342.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,418.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,474.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,490.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,500.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,335.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,309.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,309.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,309.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,464.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,309.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,309.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,464.63,
XR SHOULDER ARTHROGRAPHY INJ,4501400,CDM,320,RC,,,outpatient,,,149.25,74.63,,144.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.33,
"Flouroscopy, or x-ray ""movie"" that takes less than an hour",4501500,CDM,320,RC,,,outpatient,,,472.5,236.25,,458.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,283.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,425.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,425.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,283.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,343.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,322.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,283.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,381.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,418.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,313.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,382.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,434.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,448.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,458.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,307.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,283.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,283.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,283.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,425.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,283.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,283.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,425.25,
One sided or limited bilateral study,4501971,CDM,921,RC,,,outpatient,,,796.25,398.13,,772.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,716.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,716.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,716.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,579.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,543.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,642.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,642.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,705.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,527.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,644.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,732.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,756.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,772.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,517.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,716.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,716.63,
MRI ORBIT/FACE/NECK W/O CONT,4502001,CDM,614,RC,,,outpatient,,,2728,1364,,2646.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,1636.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2455.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,2455.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,1636.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1984.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1861.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1636.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2202.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2202.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2417.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1808.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2209.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2509.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,2591.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,2646.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,1773.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,1636.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1636.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1636.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2455.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,1636.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1636.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2455.2,
MRI of brain stem without dye,4502005,CDM,611,RC,,,outpatient,,,2818.75,1409.38,,2734.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,1691.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2536.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,2536.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,1691.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2050.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1923.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1691.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2275.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2275.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2497.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1868.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2283.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2593.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,2677.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,2734.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,1832.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,1691.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1691.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1691.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2536.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,1691.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1691.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2536.88,
MRI BRAIN W CONTRAST,4502006,CDM,611,RC,,,outpatient,,,3219.5,1609.75,,3122.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,1931.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,276.18,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2897.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,2897.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,1931.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2342.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2197.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1931.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2598.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2598.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2852.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2134.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2607.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2961.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,3058.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,3122.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,2092.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,1931.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1931.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1931.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2897.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,1931.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1931.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2897.55,
MRI scan of brain before and after contrast,4502007,CDM,611,RC,,,outpatient,,,4756.75,2378.38,,4614.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,2854.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,326.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4281.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4281.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,2854.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3461.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3246.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2854.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3839.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3839.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4214.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3153.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3852.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4376.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,4518.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,4614.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,3091.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,2854.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2854.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2854.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4281.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,2854.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,2854.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4281.08,
MRI of the neck or spine without dye,4502008,CDM,612,RC,,,outpatient,,,2657,1328.5,,2577.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1594.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195.28,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2391.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,2391.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1594.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1933.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1813.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1594.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2144.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2144.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2354.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1761.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2152.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2444.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,2524.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,2577.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,1727.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,1594.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1594.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1594.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2391.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1594.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1594.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2391.3,
MRI C SPINE W/CONT,4502009,CDM,612,RC,,,outpatient,,,3249.75,1624.88,,3152.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,1949.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,281.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2924.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,2924.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,1949.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2364.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2217.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1949.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2623.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2623.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2879.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2154.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2632.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2989.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,3087.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,3152.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,2112.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,1949.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1949.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1949.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2924.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,1949.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1949.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2924.78,
MRI of neck/spine with and without dye,4502010,CDM,612,RC,,,outpatient,,,4771.75,2385.88,,4628.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,2863.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4294.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,4294.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,2863.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3471.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3256.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2863.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3851.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3851.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4228.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3163.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3865.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4390.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,4533.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,4628.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,3101.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,2863.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2863.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2863.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4294.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,2863.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,2863.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4294.58,
MRI of chest and spine without dye,4502012,CDM,612,RC,,,outpatient,,,2784.25,1392.13,,2700.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,1670.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195.58,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2505.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,2505.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,1670.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2025.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1900.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1670.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2247.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2247.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2467.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1845.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2255.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2561.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,2645.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,2700.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,1809.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,1670.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1670.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1670.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2505.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,1670.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1670.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2505.83,
MRI DORSAL W/CONTRAST,4502013,CDM,612,RC,,,outpatient,,,3058,1529,,2966.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,1834.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,279.77,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2752.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,2752.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,1834.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2225,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2087.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1834.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2468.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2468.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2709.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2027.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2476.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2813.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,2905.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,2966.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,1987.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,1834.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1834.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1834.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2752.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,1834.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1834.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2752.2,
MRI of chest and spine with and without dye,4502014,CDM,612,RC,,,outpatient,,,4623.75,2311.88,,4485.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,2774.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,329.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4161.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,4161.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2774.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3364.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3155.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2774.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3732.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3732.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4097.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3065.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3745.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4253.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,4392.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,4485.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,3005.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,2774.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2774.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2774.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4161.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2774.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,2774.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4161.38,
MRI scan of lower spil cal,4502016,CDM,612,RC,,,outpatient,,,2754.75,1377.38,,2672.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,1652.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195.58,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2479.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,2479.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1652.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2004.36,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1880.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1652.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2223.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2223.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2440.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1826.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2231.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2534.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,2617.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,2672.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,1790.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,1652.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1652.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1652.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2479.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1652.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1652.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2479.28,
MRI L SPINE W/CONT,4502017,CDM,612,RC,,,outpatient,,,2952.5,1476.25,,2863.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,1771.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,278.13,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2657.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,2657.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1771.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2148.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2015.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1771.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2383.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2383.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2616.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1957.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2391.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2716.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,2804.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,2863.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,1919.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,1771.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1771.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1771.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2657.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1771.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1771.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2657.25,
MRI of lower back with and without dye,4502018,CDM,612,RC,,,outpatient,,,4721,2360.5,,4579.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,2832.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.32,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4248.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,4248.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,2832.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3435,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3222.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2832.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3810.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3810.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4183.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3130.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3824.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4343.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,4484.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,4579.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,3068.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,2832.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2832.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2832.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4248.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,2832.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,2832.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4248.9,
"Radiologic examition, elbow; 2 views",4502019,CDM,320,RC,,,outpatient,,,136,68,,131.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.83,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,122.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,122.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,92.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,109.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,90.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,110.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,125.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,129.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,131.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,122.4,
Radiologic examition of the forearm,4502025,CDM,320,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.77,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
MRI TMJ,4502026,CDM,614,RC,,,outpatient,,,2606.75,1303.38,,2528.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,1564.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,263.28,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2346.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,2346.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,1564.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1896.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1779.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1564.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2104.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2104.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2309.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1728.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2111.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2398.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,2476.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,2528.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,1694.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,1564.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1564.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1564.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2346.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,1564.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1564.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2346.08,
MRI of abdomen without and with dye,4502028,CDM,614,RC,,,outpatient,,,4224.5,2112.25,,4097.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,2534.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,350.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3802.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,3802.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,2534.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3073.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2883.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2534.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3410.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3410.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3743.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2800.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3421.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3886.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,4013.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,4097.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,2745.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,2534.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2534.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2534.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3802.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,2534.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,2534.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3802.05,
MRI of abdomen without dye,4502029,CDM,614,RC,,,outpatient,,,2601.25,1300.63,,2523.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,1560.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.8,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2341.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,2341.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,1560.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1892.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1775.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1560.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2099.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2099.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2304.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1724.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2107.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2393.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,2471.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,2523.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,1690.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,1560.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1560.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1560.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2341.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,1560.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1560.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2341.13,
MRI CHEST W/O CONTRAST,4502034,CDM,614,RC,,,outpatient,,,2968.25,1484.13,,2879.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,1780.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.13,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2671.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,2671.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,1780.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2159.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2025.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1780.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2395.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2395.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2630.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1967.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2404.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2730.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,2819.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,2879.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,1929.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,1780.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1780.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1780.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2671.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,1780.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1780.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2671.43,
Radiologic examition of the knee with 1 or 2 views,4502036,CDM,320,RC,,,outpatient,,,144,72,,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,116.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,136.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,129.6,
Radiologic examition of one side of the chest/ribs,4502050,CDM,320,RC,,,outpatient,,,197.25,98.63,,191.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,177.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,177.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,134.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,159.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,130.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,159.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,181.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,187.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,191.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,128.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,177.53,
XR SCAPULA LEFT,4502054,CDM,320,RC,,,outpatient,,,144,72,,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,116.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,136.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,129.6,
Radiologic examition of the shoulder,4502057,CDM,320,RC,,,outpatient,,,153.25,76.63,,148.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.67,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,137.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,104.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,101.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,124.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,140.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,145.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,148.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,137.93,
MRA PELV W OR WO CONT,4502060,CDM,618,RC,,,outpatient,,,2944.5,1472.25,,2856.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,1766.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,343.08,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2650.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,2650.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1766.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2142.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2009.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1766.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2376.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2376.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2609.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1952.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2385.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2708.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,2797.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,2856.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,1913.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,1766.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1766.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1766.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2650.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1766.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1766.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2650.05,
XR LT HIP W PELVIS 2/3 V,4502067,CDM,320,RC,,,outpatient,,,313.5,156.75,,304.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,188.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.66,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,282.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,282.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,188.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,213.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,188.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,253.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,253.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,277.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,207.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,253.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,288.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,297.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,304.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,203.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,188.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,282.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,188.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,188.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,282.15,
Radiologic examition of the knee with 4 or more views,4502071,CDM,320,RC,,,outpatient,,,190.75,95.38,,185.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,171.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,171.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,130.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,153.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,153.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,169.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,126.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,154.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,175.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,181.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,185.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,123.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,114.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,171.68,
Radiologic examition of the lower leg,4502075,CDM,320,RC,,,outpatient,,,139.5,69.75,,135.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.97,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,113,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,128.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,135.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,125.55,
MRI of leg without dye,4502078,CDM,614,RC,,,outpatient,,,4106.5,2053.25,,3983.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,2463.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,229.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3695.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3695.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,2463.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2987.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2802.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2463.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3314.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3314.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3638.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2722.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3326.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3777.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,3901.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,3983.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,2669.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,2463.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2463.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2463.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3695.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,2463.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,2463.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3695.85,
MRI UP EXT JT W W/O CONT BIL,4502080,CDM,614,RC,,,outpatient,,,6867.75,3433.88,,6661.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,4120.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,402.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,6180.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,6180.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,4120.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4996.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4687.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4120.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5543.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5543.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6085.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4553.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5562.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6318.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,6524.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,6661.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,4464.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,4120.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4120.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4120.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6180.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,4120.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,4120.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,6180.98,
Up to 3 views,4502083,CDM,320,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
XR SACROILAC JOINTS <3V,4502088,CDM,320,RC,,,outpatient,,,145.25,72.63,,140.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,99.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,117.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,96.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,133.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,87.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.73,
MRI of pelvis without dye,4502090,CDM,614,RC,,,outpatient,,,2787,1393.5,,2703.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,1672.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,236.97,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2508.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,2508.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1672.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2027.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1902.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1672.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2249.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2249.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2469.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1847.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2257.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2564.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,2647.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,2703.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,1811.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,1672.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1672.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1672.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2508.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1672.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1672.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2508.3,
MRI of pelvis before and after dye,4502092,CDM,614,RC,,,outpatient,,,4745.75,2372.88,,4603.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,2847.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,350.04,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4271.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,4271.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,2847.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3453.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3238.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2847.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3830.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3830.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4205.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3146.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3844.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4366.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,4508.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,4603.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,3084.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,2847.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2847.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2847.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4271.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,2847.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,2847.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4271.18,
MRI CHEST W/WO CONTRAST,4502096,CDM,614,RC,,,outpatient,,,5038.25,2519.13,,4887.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,3022.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,430.78,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4534.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4534.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,3022.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3665.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3438.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3022.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4066.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4066.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4464.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3340.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4080.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4635.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,4786.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,4887.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,3274.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,3022.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3022.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3022.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4534.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,3022.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,3022.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4534.43,
MRA NECK W WO CONT,4502100,CDM,615,RC,,,outpatient,,,4138.25,2069.13,,4014.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,2482.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,371.1,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3724.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,3724.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,2482.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3010.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2824.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2482.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3340.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3340.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3666.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2743.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3351.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3807.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,3931.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,4014.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,2689.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,2482.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2482.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2482.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3724.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,2482.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,2482.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3724.43,
Radiologic examition of the ankle with 2 views,4502105,CDM,320,RC,,,outpatient,,,136,68,,131.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.17,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,122.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,122.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,92.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,109.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,90.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,110.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,125.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,129.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,131.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,122.4,
MRA HEAD W WO CONT,4502106,CDM,615,RC,,,outpatient,,,3931.25,1965.63,,3813.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,2358.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,353.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3538.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,3538.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,2358.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2860.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2683.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2358.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3173.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3173.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3483.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2606.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3184.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3616.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,3734.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,3813.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,2555.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,2358.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2358.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2358.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3538.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,2358.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,2358.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3538.13,
MRA HEAD W O CONT,4502110,CDM,615,RC,,,outpatient,,,2635.25,1317.63,,2556.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,1581.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2371.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,2371.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1581.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1917.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1798.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1581.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2127.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2127.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2335.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1747.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2134.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2424.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,2503.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,2556.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,1712.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,1581.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1581.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1581.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2371.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1581.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1581.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2371.73,
MRI ORBIT/FACE/NECK W/WO CONT,4502112,CDM,614,RC,,,outpatient,,,4689.5,2344.75,,4548.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,2813.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,347.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4220.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,4220.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,2813.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3412.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3200.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2813.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3785.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3785.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4155.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3109.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3798.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4314.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,4455.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,4548.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,3048.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,2813.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2813.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2813.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4220.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,2813.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,2813.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4220.55,
MRI ORBIT/FACE/NECK W/CONT,4502114,CDM,614,RC,,,outpatient,,,3115,1557.5,,3021.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,1869,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,276.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2803.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,2803.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,1869,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2266.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2125.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1869,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2514.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2514.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2760.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2065.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2523.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2865.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,2959.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,3021.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,2024.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,1869,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1869,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1869,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2803.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,1869,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1869,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2803.5,
X-ray of the hand with 3 or more views,4502127,CDM,320,RC,,,outpatient,,,153.25,76.63,,148.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.32,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,137.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,104.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,101.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,124.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,140.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,145.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,148.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,137.93,
MRA CHEST W WO CONT,4502128,CDM,618,RC,,,outpatient,,,2966.5,1483.25,,2877.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,1779.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,341.18,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2669.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,2669.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,1779.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2158.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2024.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1779.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2394.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2394.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2628.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1966.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2402.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2729.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,2818.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,2877.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,1928.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,1779.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1779.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1779.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2669.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,1779.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1779.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2669.85,
"XR HIP, UNILAT W/PELVIS 1V RT",4502129,CDM,320,RC,,,outpatient,,,301.5,150.75,,292.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,180.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,271.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,271.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,180.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,219.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,205.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,180.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,267.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,199.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,244.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,277.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,286.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,292.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,195.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,180.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,180.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,180.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,271.35,
MRA ABD W WO CONT,4502140,CDM,618,RC,,,outpatient,,,5887,2943.5,,5710.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,3532.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,344.28,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,5298.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,5298.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,3532.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4283.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4017.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3532.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4751.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4751.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5216.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3903.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4768.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5416.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,5592.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,5710.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,3826.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,3532.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3532.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3532.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5298.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,3532.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,3532.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,5298.3,
CT LOW EXT W/CONT LT,4502143,CDM,352,RC,,,outpatient,,,1598.25,799.13,,1550.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,958.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.57,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1438.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,1438.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,958.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1162.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1090.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,958.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1290.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1290.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1416.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1059.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1294.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1470.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,1518.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,1550.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,1038.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,958.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,958.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,958.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1438.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,958.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,958.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1438.43,
CT LOW EXT W/WO CONT LT,4502145,CDM,352,RC,,,outpatient,,,2024.25,1012.13,,1963.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,1214.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1821.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,1821.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,1214.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1472.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1381.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1214.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1633.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1633.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1793.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1342.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1639.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1862.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,1923.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,1963.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,1315.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,1214.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1214.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1214.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1821.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,1214.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1214.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1821.83,
XR SPINE LUM COMP W BEND MIN 6V,4502160,CDM,320,RC,,,outpatient,,,344.25,172.13,,333.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,206.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.19,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,309.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,309.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,206.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,234.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,206.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,277.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,277.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,305.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,228.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,278.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,316.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,327.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,333.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,223.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,206.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,309.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,206.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,206.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,309.83,
XR SPINE LUMB BEND ONLY 2 OR 3 V,4502162,CDM,320,RC,,,outpatient,,,238.75,119.38,,231.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,143.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.66,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,214.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,214.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,143.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,162.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,143.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,192.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,211.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,158.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,193.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,219.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,226.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,231.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,143.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,143.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,143.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,214.88,
CT UP EX W/CONT LT,4502163,CDM,352,RC,,,outpatient,,,1590.75,795.38,,1543.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,954.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195.17,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1431.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1431.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,954.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1157.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1085.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,954.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1284.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1284.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1409.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1054.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1288.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1463.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,1511.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,1543.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,1033.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,954.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,954.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,954.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1431.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,954.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,954.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1431.68,
XR MANDIBLE < 4V,4502164,CDM,320,RC,,,outpatient,,,150.25,75.13,,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135.23,
CT UP EX W/W/O CONT LT,4502165,CDM,352,RC,,,outpatient,,,2006.5,1003.25,,1946.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,1203.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.23,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1805.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,1805.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,1203.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1459.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1369.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1203.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1619.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1619.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1777.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1330.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1625.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1845.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,1906.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,1946.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,1304.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,1203.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1203.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1203.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1805.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,1203.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1203.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1805.85,
XR BONE LENGTH STUDY,4502170,CDM,320,RC,,,outpatient,,,203.25,101.63,,197.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.57,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,182.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,138.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,164.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,180.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,134.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,164.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,186.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,193.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,197.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,132.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,121.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,182.93,
XR UGI W AIR CONT W/O KUB,4502182,CDM,320,RC,,,outpatient,,,578,289,,560.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,346.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,520.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,520.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,346.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,420.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,394.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,346.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,466.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,466.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,512.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,383.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,468.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,531.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,549.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,560.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,375.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,346.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,346.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,346.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,520.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,346.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,346.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,520.2,
"Radiologic examition, elbow; 3 or more views",4502203,CDM,320,RC,,,outpatient,,,167.75,83.88,,162.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.32,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,150.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,111.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,154.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,159.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.98,
3 or more views,4502204,CDM,320,RC,,,outpatient,,,139.5,69.75,,135.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,113,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,128.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,135.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,125.55,
X-ray of the hand with 2 views,4502205,CDM,320,RC,,,outpatient,,,136,68,,131.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.67,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,122.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,122.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,92.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,109.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,90.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,110.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,125.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,129.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,131.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,81.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,122.4,
Radiologic examition of the ankle with 3 views,4502207,CDM,320,RC,,,outpatient,,,153.25,76.63,,148.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.32,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,137.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,104.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,101.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,124.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,140.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,145.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,148.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,137.93,
Radiologic examition of the foot with 3 or more views,4502208,CDM,320,RC,,,outpatient,,,153.25,76.63,,148.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.52,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,137.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,104.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,101.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,124.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,140.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,145.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,148.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,91.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,137.93,
"Radiologic examition, foot; 2 views",4502224,CDM,320,RC,,,outpatient,,,134.75,67.38,,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,123.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.28,
Radiologic examition of the heel,4502228,CDM,320,RC,,,outpatient,,,132.5,66.25,,128.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,119.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,90.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,117.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,107.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,121.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,125.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,128.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,79.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,119.25,
XR HUMERUS 2V LEFT,4502230,CDM,320,RC,,,outpatient,,,150.25,75.13,,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.57,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,138.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,90.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,135.23,
XR RIBS UNIL LEFT 2V,4502242,CDM,320,RC,,,outpatient,,,164.25,82.13,,159.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,147.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,147.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,112.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,145.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,108.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,133.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,151.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,156.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,159.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,147.83,
MRI of upper extremity without dye,4503020,CDM,614,RC,,,outpatient,,,2671,1335.5,,2590.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,1602.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2403.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,2403.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,1602.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1943.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1822.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1602.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2156.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2156.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2366.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1770.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2163.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2457.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,2537.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,2590.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,1736.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,1602.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1602.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1602.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2403.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,1602.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1602.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2403.9,
MRI LOWER EXT W  W/O CONT RT,4503024,CDM,614,RC,,,outpatient,,,4709.75,2354.88,,4568.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,2825.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,348.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4238.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,4238.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,2825.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3426.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3214.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2825.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3801.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3801.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4173.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3122.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3814.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4332.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,4474.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,4568.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,3061.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,2825.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2825.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2825.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4238.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,2825.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,2825.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4238.78,
MRI of lower extremity joint (knee/ankle) without dye,4503027,CDM,614,RC,,,outpatient,,,2700.75,1350.38,,2619.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,1620.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2430.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,2430.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1620.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1965.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1843.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1620.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2180.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2180.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2393.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1790.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2187.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2484.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,2565.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,2619.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,1755.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,1620.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1620.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1620.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2430.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1620.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1620.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2430.68,
MRA UP EXT W OR WO CONT RT,4503066,CDM,618,RC,,,outpatient,,,2882,1441,,2795.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,1729.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,338.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2593.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2593.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1729.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2096.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1966.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1729.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2326.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2326.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2553.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1910.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2334.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2651.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,2737.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,2795.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,1873.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,1729.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1729.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1729.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2593.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1729.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1729.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2593.8,
MRI of lower extremity joint (knee/ankle) with and without dye,4503072,CDM,614,RC,,,outpatient,,,4578.25,2289.13,,4440.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,401.16,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4120.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4120.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3331.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3124.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3695.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3695.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4056.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3035.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3708.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4211.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,4349.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,4440.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,2975.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4120.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4120.43,
MRI of lower extremity joint (knee/ankle) with dye,4503074,CDM,614,RC,,,outpatient,,,3039.75,1519.88,,2948.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,1823.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,324.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2735.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,2735.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,1823.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2211.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2074.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1823.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2453.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2453.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2693.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2015.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2462.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2796.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,2887.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,2948.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,1975.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,1823.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1823.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1823.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2735.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,1823.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1823.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2735.78,
MRI LOWER EXT W CONTR RIGHT,4503076,CDM,614,RC,,,outpatient,,,3125.75,1562.88,,3031.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2813.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,2813.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2274.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2133.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2523.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2523.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2769.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2072.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2531.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2875.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,2969.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,3031.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,2031.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2813.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2813.18,
MRI of leg without dye,4503078,CDM,614,RC,,,outpatient,,,2737.75,1368.88,,2655.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,1642.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,229.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2463.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,2463.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,1642.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1991.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1868.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1642.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2209.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2209.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2425.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1815.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2217.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2518.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,2600.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,2655.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,1779.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,1642.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1642.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1642.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2463.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,1642.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1642.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2463.98,
MRI UP EXT JT W W/O CONT RT,4503080,CDM,614,RC,,,outpatient,,,4578.25,2289.13,,4440.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,402.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4120.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4120.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3331.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3124.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3695.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3695.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4056.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3035.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3708.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4211.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,4349.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,4440.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,2975.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4120.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4120.43,
MRI UP EXT JT W CONT RT,4503082,CDM,614,RC,,,outpatient,,,3022.5,1511.25,,2931.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,1813.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,323.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2720.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,2720.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1813.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2199.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2062.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1813.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2439.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2439.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2678.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2003.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2448.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2780.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,2871.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,2931.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,1964.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,1813.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1813.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1813.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2720.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1813.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1813.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2720.25,
MRI UP EXT W W/O CONT RT,4503084,CDM,614,RC,,,outpatient,,,3125.75,1562.88,,3031.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,257.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2813.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,2813.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2274.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2133.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2523.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2523.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2769.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2072.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2531.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2875.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,2969.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,3031.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,2031.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2813.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2813.18,
MRI UP EXT W CONT RT,4503085,CDM,614,RC,,,outpatient,,,3125.75,1562.88,,3031.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2813.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,2813.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2274.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2133.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2523.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2523.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2769.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2072.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2531.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2875.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,2969.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,3031.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,2031.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2813.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2813.18,
MRI UP EXT W/O CONT RT,4503086,CDM,614,RC,,,outpatient,,,2773.25,1386.63,,2690.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,1663.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,257.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2495.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,2495.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1663.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2017.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1892.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1663.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2238.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2238.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2457.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1838.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2246.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2551.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,2634.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,2690.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,1802.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,1663.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1663.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1663.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2495.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1663.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1663.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2495.93,
X-ray of the hand with 2 views,4503120,CDM,320,RC,,,outpatient,,,58,29,,56.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.67,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,52.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,46.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,53.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,55.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,56.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.8,102.86,
One sided or limited bilateral study,4503124,CDM,921,RC,,,outpatient,,,796.25,398.13,,772.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,716.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,716.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,716.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,579.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,543.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,642.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,642.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,705.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,527.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,644.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,732.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,756.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,772.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,517.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,716.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,716.63,
US CAROTID DOPPLER UNILAT RT,4503127,CDM,921,RC,,,outpatient,,,760.75,380.38,,737.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,456.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,684.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,684.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,684.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,456.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,553.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,519.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,456.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,614.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,614.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,674.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,504.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,616.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,699.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,722.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,737.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,494.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,456.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,456.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,456.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,684.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,456.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,456.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,684.68,
MRA LOW EXT WO CONT RT,4503131,CDM,616,RC,,,outpatient,,,2952,1476,,2863.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,1771.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,343.48,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2656.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2656.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1771.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2147.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2014.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1771.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2382.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2382.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2615.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1957.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2391.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2715.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,2804.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,2863.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,1918.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,1771.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1771.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1771.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2656.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1771.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1771.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2656.8,
CT UP EX W/O CONT LT,4503164,CDM,352,RC,,,outpatient,,,1335.75,667.88,,1295.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1202.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1202.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,971.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,911.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1078.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1078.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1183.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,885.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1081.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1228.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,1268.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,1295.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,868.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1202.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1202.18,
XR ARTHRITIS SERIES FEET,4503620,CDM,320,RC,,,outpatient,,,83.75,41.88,,81.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.67,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,75.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,57.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,55.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,67.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,77.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,79.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,81.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.25,102.86,
Complete bilateral study of the extremities,4503970,CDM,921,RC,,,outpatient,,,1138,569,,1103.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,682.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1024.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,1024.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,1024.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,682.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,828.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,776.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,682.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,918.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,918.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1008.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,754.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,921.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1046.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,1081.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,1103.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,739.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,682.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,682.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,682.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1024.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,682.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,682.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1024.2,
One sided or limited bilateral study,4503971,CDM,921,RC,,,outpatient,,,796.25,398.13,,772.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,716.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,716.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,716.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,579.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,543.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,642.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,642.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,705.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,527.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,644.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,732.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,756.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,772.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,517.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,716.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,477.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,716.63,
MRI of upper extremity without dye,4504020,CDM,614,RC,,,outpatient,,,2671,1335.5,,2590.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,1602.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2403.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,2403.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,1602.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1943.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1822.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1602.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2156.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2156.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2366.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1770.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2163.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2457.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,2537.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,2590.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,1736.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,1602.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1602.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1602.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2403.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,1602.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1602.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2403.9,
MRI LOWER EXT W  W/O CONT LT,4504024,CDM,614,RC,,,outpatient,,,4709.75,2354.88,,4568.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,2825.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,348.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4238.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,4238.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,2825.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3426.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3214.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2825.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3801.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3801.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4173.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3122.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3814.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4332.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,4474.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,4568.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,3061.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,2825.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2825.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2825.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4238.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,2825.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,2825.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4238.78,
MRI of lower extremity joint (knee/ankle) without dye,4504027,CDM,614,RC,,,outpatient,,,2700.75,1350.38,,2619.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,1620.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2430.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,2430.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1620.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1965.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1843.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1620.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2180.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2180.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2393.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1790.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2187.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2484.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,2565.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,2619.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,1755.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,1620.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1620.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1620.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2430.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1620.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1620.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2430.68,
MRA UP EXT W OR W O CONT LT,4504066,CDM,618,RC,,,outpatient,,,2882,1441,,2795.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,1729.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,338.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2593.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2593.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1729.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2096.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1966.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1729.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2326.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2326.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2553.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1910.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2334.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2651.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,2737.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,2795.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,1873.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,1729.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1729.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1729.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2593.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1729.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1729.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2593.8,
MRI of lower extremity joint (knee/ankle) with and without dye,4504072,CDM,614,RC,,,outpatient,,,4578.25,2289.13,,4440.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,401.16,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4120.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4120.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3331.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3124.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3695.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3695.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4056.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3035.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3708.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4211.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,4349.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,4440.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,2975.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4120.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4120.43,
MRI of lower extremity joint (knee/ankle) with dye,4504074,CDM,614,RC,,,outpatient,,,3039.75,1519.88,,2948.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,1823.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,324.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2735.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,2735.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,1823.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2211.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2074.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1823.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2453.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2453.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2693.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2015.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2462.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2796.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,2887.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,2948.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,1975.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,1823.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1823.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1823.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2735.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,1823.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1823.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2735.78,
MRI LOWER EXT W CONT LEFT,4504076,CDM,614,RC,,,outpatient,,,3125.75,1562.88,,3031.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2813.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,2813.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2274.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2133.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2523.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2523.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2769.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2072.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2531.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2875.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,2969.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,3031.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,2031.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2813.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2813.18,
MRI of leg without dye,4504078,CDM,614,RC,,,outpatient,,,2737.75,1368.88,,2655.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,1642.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,229.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2463.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,2463.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,1642.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1991.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1868.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1642.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2209.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2209.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2425.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1815.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2217.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2518.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,2600.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,2655.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,1779.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,1642.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1642.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1642.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2463.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,1642.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1642.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2463.98,
MRI UP EXT JT W W/O CONT LT,4504080,CDM,614,RC,,,outpatient,,,4578.25,2289.13,,4440.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,402.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4120.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4120.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3331.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3124.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3695.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3695.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4056.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3035.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3708.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4211.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,4349.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,4440.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,2975.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4120.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,2746.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4120.43,
MRI UP EXT JT W CONT LT,4504082,CDM,614,RC,,,outpatient,,,3022.5,1511.25,,2931.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,1813.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,323.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2720.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,2720.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1813.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2199.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2062.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1813.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2439.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2439.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2678.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2003.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2448.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2780.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,2871.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,2931.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,1964.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,1813.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1813.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1813.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2720.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1813.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1813.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2720.25,
MRI UP EXT W W/O CONT LT,4504084,CDM,614,RC,,,outpatient,,,3125.75,1562.88,,3031.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,424.83,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2813.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,2813.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2274.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2133.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2523.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2523.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2769.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2072.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2531.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2875.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,2969.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,3031.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,2031.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2813.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2813.18,
MRI UP EXT W CONT LT,4504085,CDM,614,RC,,,outpatient,,,3125.75,1562.88,,3031.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2813.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,2813.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2274.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2133.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2523.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2523.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2769.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2072.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2531.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2875.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,2969.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,3031.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,2031.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2813.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1875.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2813.18,
MRI UP EXT W/O CONT LT,4504086,CDM,614,RC,,,outpatient,,,2773.25,1386.63,,2690.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,1663.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,257.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2495.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,2495.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1663.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2017.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1892.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1663.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2238.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2238.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2457.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1838.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2246.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2551.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,2634.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,2690.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,1802.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,1663.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1663.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1663.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2495.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1663.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1663.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2495.93,
CT of abdomen without dye,4504088,CDM,352,RC,,,outpatient,,,1401.5,700.75,,1359.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,840.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.6,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1261.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,1261.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,840.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1019.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,956.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,840.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1131.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1131.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1241.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,929.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1135.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1289.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,1331.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,1359.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,910.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,840.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,840.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,840.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1261.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,840.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,840.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1261.35,
CT of abdomen with dye,4504089,CDM,352,RC,,,outpatient,,,1799.25,899.63,,1745.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,1079.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.9,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1619.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1619.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1079.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1309.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1227.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1079.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1452.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1452.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1594.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1192.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1457.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1655.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,1709.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,1745.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,1169.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,1079.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1079.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1079.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1619.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1079.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1079.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1619.33,
CT of abdomen with dye,4504090,CDM,352,RC,,,outpatient,,,1799.25,899.63,,1745.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,1079.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.9,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1619.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1619.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1079.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1309.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1227.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1079.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1452.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1452.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1594.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1192.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1457.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1655.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,1709.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,1745.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,1169.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,1079.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1079.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1079.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1619.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1079.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1079.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1619.33,
CT of abdomen without dye,4504091,CDM,352,RC,,,outpatient,,,1401.5,700.75,,1359.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,840.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.6,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1261.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,1261.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,840.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1019.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,956.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,840.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1131.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1131.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1241.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,929.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1135.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1289.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,1331.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,1359.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,910.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,840.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,840.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,840.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1261.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,840.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,840.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1261.35,
"CT scan, pelvis, with contrast",4504093,CDM,352,RC,,,outpatient,,,1654.5,827.25,,1604.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,992.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,204.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1489.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1489.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,992.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1203.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1129.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,992.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1335.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1335.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1466.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1096.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1340.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1522.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,1571.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,1604.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,1075.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,992.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,992.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,992.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1489.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,992.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,992.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1489.05,
"CT scan, pelvis, with contrast",4504094,CDM,352,RC,,,outpatient,,,1654.5,827.25,,1604.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,992.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,204.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1489.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1489.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,992.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1203.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1129.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,992.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1335.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1335.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1466.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1096.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1340.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1522.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,1571.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,1604.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,1075.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,992.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,992.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,992.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1489.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,992.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,992.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1489.05,
CT of abdomen and pelvis without dye,4504096,CDM,352,RC,,,outpatient,,,2802,1401,,2717.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,1681.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,179.65,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2521.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2521.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1681.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2038.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1912.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1681.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2261.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2261.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2482.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1857.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2269.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2577.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,2661.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,2717.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,1821.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,1681.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1681.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1681.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2521.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1681.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1681.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2521.8,
CT scan of abdomen and pelvis with contrast,4504097,CDM,352,RC,,,outpatient,,,3451.75,1725.88,,3348.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,2071.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,280.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3106.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,3106.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,2071.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2511.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2355.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2071.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2786.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2786.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3058.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2288.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2795.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3175.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,3279.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,3348.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,2243.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,2071.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2071.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2071.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3106.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,2071.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,2071.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3106.58,
CT scan of abdomen and pelvis with contrast,4504098,CDM,352,RC,,,outpatient,,,3451.75,1725.88,,3348.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,2071.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,280.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3106.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,3106.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,2071.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2511.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2355.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2071.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2786.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2786.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3058.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2288.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2795.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3175.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,3279.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,3348.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,2243.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,2071.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2071.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2071.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3106.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,2071.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,2071.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3106.58,
CT of abdomen and pelvis without dye,4504099,CDM,352,RC,,,outpatient,,,2802,1401,,2717.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,1681.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,179.65,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2521.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2521.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1681.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2038.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1912.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1681.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2261.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2261.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2482.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1857.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2269.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2577.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,2661.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,2717.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,1821.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,1681.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1681.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1681.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2521.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1681.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1681.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2521.8,
CT scan of the thorax without dye,4504104,CDM,352,RC,,,outpatient,,,1453.75,726.88,,1410.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,872.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.94,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1308.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,1308.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,872.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1057.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,992.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,872.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1173.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1173.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1288.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,963.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1177.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1337.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,1381.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,1410.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,944.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,872.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,872.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,872.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1308.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,872.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,872.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1308.38,
CT scan of the thorax with dye,4504105,CDM,352,RC,,,outpatient,,,1735.25,867.63,,1683.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,1041.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.1,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1561.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1561.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1041.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1262.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1184.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1041.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1400.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1400.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1537.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1150.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1405.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1596.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,1648.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,1683.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,1127.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,1041.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1041.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1041.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1561.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1041.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1041.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1561.73,
CT of abdomen with and without dye,4504107,CDM,352,RC,,,outpatient,,,1799.25,899.63,,1745.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,1079.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.77,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1619.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1619.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1079.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1309.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1227.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1079.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1452.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1452.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1594.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1192.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1457.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1655.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,1709.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,1745.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,1169.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,1079.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1079.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1079.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1619.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1079.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1079.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1619.33,
CT of abdomen with and without dye,4504109,CDM,352,RC,,,outpatient,,,2304.75,1152.38,,2235.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,1382.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.77,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2074.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,2074.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1382.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1676.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1572.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1382.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1860.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1860.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2042.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1528.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1866.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2120.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,2189.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,2235.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,1498.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,1382.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1382.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1382.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2074.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1382.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1382.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2074.28,
CT PELVIS WO & WITH IV ONLY,4504110,CDM,352,RC,,,outpatient,,,1654.5,827.25,,1604.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,992.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1489.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1489.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,992.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1203.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1129.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,992.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1335.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1335.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1466.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1096.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1340.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1522.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,1571.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,1604.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,1075.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,992.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,992.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,992.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1489.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,992.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,992.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1489.05,
"Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections ",4504113,CDM,352,RC,,,outpatient,,,4378,2189,,4246.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,2626.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,316.13,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3940.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,3940.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,2626.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3185.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2987.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2626.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3533.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3533.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3879.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2902.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3546.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4027.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,4159.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,4246.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,2845.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,2626.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2626.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2626.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3940.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,2626.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,2626.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3940.2,
CT of abdomen and pelvis without dye,4504114,CDM,352,RC,,,outpatient,,,2802,1401,,2717.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,1681.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,179.65,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2521.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2521.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1681.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2038.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1912.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1681.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2261.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2261.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2482.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1857.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2269.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2577.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,2661.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,2717.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,1821.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,1681.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1681.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1681.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2521.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1681.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1681.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2521.8,
"Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections ",4504115,CDM,352,RC,,,outpatient,,,4378,2189,,4246.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,2626.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,316.13,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3940.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,3940.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,2626.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3185.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2987.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2626.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3533.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3533.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3879.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2902.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3546.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4027.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,4159.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,4246.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,2845.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,2626.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2626.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2626.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3940.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,2626.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,2626.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3940.2,
CT THORAX WO & W IV ONLY,4504119,CDM,352,RC,,,outpatient,,,2141.75,1070.88,,2077.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,1285.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,204.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1927.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1927.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1285.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1558.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1461.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1285.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1728.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1728.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1897.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1419.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1734.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1970.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,2034.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,2077.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,1392.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,1285.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1285.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1285.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1927.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,1285.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1285.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1927.58,
US CAROTID DOPPLER UNILAT LT,4504127,CDM,921,RC,,,outpatient,,,760.75,380.38,,737.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,456.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,684.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,684.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,684.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,456.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,553.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,519.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,456.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,614.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,614.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,674.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,504.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,616.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,699.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,722.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,737.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,494.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,456.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,456.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,456.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,684.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,456.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,456.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,684.68,
CT scan of leg without dye,4505144,CDM,352,RC,,,outpatient,,,1335.75,667.88,,1295.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1202.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1202.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,971.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,911.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1078.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1078.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1183.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,885.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1081.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1228.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,1268.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,1295.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,868.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1202.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,801.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1202.18,
US BREAST BILAT,4506641,CDM,402,RC,,,outpatient,,,970.5,485.25,,941.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,582.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,873.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,873.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,582.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,706.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,662.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,582.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,783.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,783.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,859.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,643.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,786.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,892.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,921.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,941.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,630.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,582.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,582.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,582.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,873.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,582.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,582.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,873.45,
Limited ultrasound of the breast,4506642,CDM,402,RC,,,outpatient,,,334.5,167.25,,324.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,200.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.17,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,301.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,301.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,228.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,200.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,270.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,270.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,296.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,221.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,270.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,307.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,317.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,324.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,217.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,200.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,301.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,200.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,301.05,
XR FLUOROSCOPIC GUIDANCE PICC PLACEMENT,4507001,CDM,320,RC,,,outpatient,,,430.75,215.38,,417.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,258.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,387.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,387.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,258.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,293.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,258.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,347.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,347.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,381.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,285.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,348.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,396.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,409.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,417.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,279.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,258.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,258.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,258.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,387.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,258.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,258.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,387.68,
"Diagnostic mammography, including computer-aided detection (cad) when performed; unilateral",4507065,CDM,401,RC,,,outpatient,,,356.25,178.13,,345.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,320.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,243.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,315.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,236.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,288.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,327.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,338.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,345.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,231.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,320.63,
Mammography of both breasts-2 or more views,4507067,CDM,403,RC,,,outpatient,,,300.5,150.25,,291.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,180.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,270.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,270.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,180.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,205.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,180.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,242.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,266.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,199.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,243.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,276.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,285.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,291.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,195.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,180.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,270.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,180.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,180.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,270.45,
XR INJECTION FOR CYSTOGRAM,4508007,CDM,361,RC,,,outpatient,,,558.5,279.25,,541.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,335.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,502.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,502.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,335.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,406.36,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,381.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,335.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,450.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,450.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,494.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,370.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,452.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,513.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,530.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,541.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,363.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,335.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,335.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,335.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,502.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,335.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,335.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,502.65,
Ultrasound of the pelvis through vagi,4508019,CDM,402,RC,,,outpatient,,,563.75,281.88,,546.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,338.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.28,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,507.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,507.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,338.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,410.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,384.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,338.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,455.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,455.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,499.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,373.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,456.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,518.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,535.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,546.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,366.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,338.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,338.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,338.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,507.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,338.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,338.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,507.38,
US CYST ASP THYROID,4508029,CDM,510,RC,,,outpatient,,,667.5,333.75,,647.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.19,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,600.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,600.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,538.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,538.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,540.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,433.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,400.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,600.75,
US CYST ASP BREAST LT,4508031,CDM,510,RC,,,outpatient,,,380.75,190.38,,369.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,228.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.38,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,342.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,342.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,228.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,277.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,259.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,228.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,307.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,307.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,337.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,252.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,308.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,350.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,361.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,369.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,247.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,228.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,228.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,228.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,342.68,
XR BONE AGE STUDY,4508039,CDM,320,RC,,,outpatient,,,117.25,58.63,,113.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,105.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,80.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,107.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,111.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,105.53,
XR EYE FOREIGN BODY BIL,4508047,CDM,320,RC,,,outpatient,,,270.25,135.13,,262.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.02,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,243.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,243.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,184.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,218.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,239.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,179.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,218.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,248.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,256.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,262.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,175.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,243.23,
XR SPINE THORACOLUMBAR 2V,4508053,CDM,320,RC,,,outpatient,,,211,105.5,,204.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,126.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,189.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,189.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,126.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,153.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,144.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,126.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,170.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,186.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,139.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,170.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,194.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,200.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,204.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,137.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,126.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,189.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,126.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,126.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,189.9,
Radiologic examition of both knees,4508073,CDM,320,RC,,,outpatient,,,147.25,73.63,,142.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,132.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,100.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,88.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,97.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,119.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,135.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,139.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,142.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,88.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,88.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,132.53,
XR LOW EXT INF MIN 2V BILAT,4508075,CDM,320,RC,,,outpatient,,,274.75,137.38,,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.28,
XR BARIUM ENEMA,4508079,CDM,320,RC,,,outpatient,,,659,329.5,,639.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,395.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.23,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,593.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,593.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,395.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,479.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,449.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,395.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,531.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,531.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,583.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,436.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,533.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,606.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,626.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,639.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,428.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,395.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,395.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,395.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,593.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,395.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,395.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,593.1,
XR FB INFANT 1V CHST/ABD,4508085,CDM,320,RC,,,outpatient,,,142.25,71.13,,137.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.28,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,128.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,97.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,94.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,115.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,130.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,135.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,92.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,128.03,
"2 views, front and back",4508095,CDM,324,RC,,,outpatient,,,212.5,106.25,,206.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,127.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,191.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,191.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,145.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,127.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,171.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,140.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,172.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,195.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,201.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,206.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,138.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,127.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,191.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,127.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,191.25,
"2 views, front and back",4508096,CDM,324,RC,,,outpatient,,,212.5,106.25,,206.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,127.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,191.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,191.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,145.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,127.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,171.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,140.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,172.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,195.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,201.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,206.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,138.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,127.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,191.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,127.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,191.25,
US ART DOP LEG RIGHT,4508141,CDM,921,RC,,,outpatient,,,977.75,488.88,,948.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,586.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,879.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,879.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,879.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,586.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,711.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,667.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,586.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,789.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,789.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,866.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,648.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,791.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,899.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,928.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,948.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,635.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,586.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,586.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,586.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,879.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,586.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,586.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,879.98,
US ART DOP ARM RIGHT,4508143,CDM,921,RC,,,outpatient,,,819.75,409.88,,795.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,491.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,737.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,737.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,737.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,491.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,596.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,559.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,491.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,661.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,661.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,726.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,543.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,664,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,754.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,778.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,795.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,532.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,491.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,491.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,491.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,737.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,491.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,491.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,737.78,
XR SHOULDER 1V RIGHT,4508161,CDM,320,RC,,,outpatient,,,121.5,60.75,,117.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.13,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,109.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,98.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,111.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,115.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,117.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,109.35,
XR UPPER EXT INFANT 2V RT,4508163,CDM,320,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
XR LOW EXT INF MIN 2V RT,4508175,CDM,320,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
US ART DOP LEG LEFT,4508241,CDM,921,RC,,,outpatient,,,977.75,488.88,,948.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,586.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,879.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,879.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,879.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,586.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,711.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,667.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,586.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,789.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,789.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,866.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,648.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,791.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,899.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,928.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,948.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,635.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,586.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,586.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,586.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,879.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,586.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,586.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,879.98,
US ART DOP ARM LEFT,4508243,CDM,921,RC,,,outpatient,,,819.75,409.88,,795.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,491.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,737.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,737.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,737.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,491.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,596.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,559.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,491.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,661.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,661.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,726.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,543.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,664,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,754.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,778.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,795.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,532.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,491.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,491.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,491.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,737.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,491.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,491.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,737.78,
XR UPPER EXT INFANT 2 V LT,4508263,CDM,320,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
XR LOWER EXT INF MIN 2V LT,4508275,CDM,320,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
US ECHO W/CONTRAST LIMITED,4508924,CDM,483,RC,,,outpatient,,,563.75,281.88,,546.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,338.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,371.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,507.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,507.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,338.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,410.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,384.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,338.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,455.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,455.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,499.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,373.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,456.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,518.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,535.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,546.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,366.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,338.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,338.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,338.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,507.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,338.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,338.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,507.38,
US ECHO W/ CONTRAST COMPLETE,4508929,CDM,483,RC,,,outpatient,,,1754,877,,1701.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,1052.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,883.94,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1578.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,1578.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,1052.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1276.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1197.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1052.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1415.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1415.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1554.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1162.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1420.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1613.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,1666.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,1701.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,1140.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,1052.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1052.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1052.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1578.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,1052.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1052.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1578.6,
MM PLACEMENT OF CLIP W GUIDANCE RT,4509081,CDM,401,RC,,,outpatient,,,902.75,451.38,,875.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,541.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,579.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,812.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,812.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,541.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,656.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,616.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,541.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,728.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,728.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,799.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,598.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,731.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,830.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,857.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,875.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,586.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,541.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,541.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,541.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,812.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,541.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,541.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,812.48,
MM PLACEMENT OF CLIP W GUID RT EA  ADD,4509082,CDM,401,RC,,,outpatient,,,827,413.5,,802.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,496.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,466.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,744.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,744.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,496.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,601.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,564.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,496.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,667.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,667.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,732.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,548.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,669.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,760.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,785.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,802.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,537.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,496.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,496.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,496.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,744.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,496.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,496.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,744.3,
US BREAST BX RT,4509083,CDM,402,RC,,,outpatient,,,913.25,456.63,,885.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,547.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,566.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,821.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,821.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,547.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,664.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,623.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,547.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,737.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,737.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,809.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,605.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,739.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,840.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,867.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,885.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,593.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,547.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,547.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,547.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,821.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,547.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,547.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,821.93,
US BREAST BX RT EA ADD,4509084,CDM,402,RC,,,outpatient,,,822.75,411.38,,798.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,493.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,448.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,740.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,740.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,493.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,598.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,561.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,493.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,664.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,664.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,729.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,545.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,666.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,756.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,781.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,798.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,534.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,493.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,493.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,493.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,740.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,493.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,493.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,740.48,
MM PLACE CLIP PERCU RT,4509281,CDM,401,RC,,,outpatient,,,266,133,,258.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,159.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,239.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,239.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.54,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,181.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,159.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,214.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,235.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,176.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,215.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,244.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,252.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,258.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,172.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,159.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,239.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,159.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,239.4,
MM PLACE CLIP PERCU RT EA ADD,4509282,CDM,401,RC,,,outpatient,,,220.25,110.13,,213.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,198.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,150.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,177.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,195.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,146.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,178.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,202.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,209.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,213.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,143.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,198.23,
US PLACEMENT OF CLIP PERCU W GUID RT,4509285,CDM,402,RC,,,outpatient,,,687.5,343.75,,666.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,412.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,428.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,618.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,618.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,412.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,500.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,469.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,412.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,554.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,554.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,609.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,455.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,556.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,632.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,653.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,666.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,446.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,412.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,412.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,412.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,618.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,412.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,412.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,618.75,
US PLACE OF CLIP PERCU W GUID RT EA ADD,4509286,CDM,402,RC,,,outpatient,,,627.25,313.63,,608.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,376.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,366.18,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,564.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,564.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,376.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,456.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,428.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,376.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,506.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,506.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,555.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,415.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,508.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,577.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,595.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,608.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,407.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,376.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,376.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,376.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,564.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,376.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,376.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,564.53,
US GUID NEEDLE PLACEMENT BREAST,4510030,CDM,320,RC,,,outpatient,,,1737.25,868.63,,1685.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,1042.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,510.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1563.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,1563.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,1042.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1264.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1185.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1042.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1402.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1402.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1539.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1151.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1407.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1598.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,1650.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,1685.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,1129.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,1042.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1042.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1042.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1563.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,1042.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1042.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1563.53,
XR SHOULDER ARTHROGRAPHY W SUPER LT,4513040,CDM,320,RC,,,outpatient,,,269.5,134.75,,261.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.79,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,242.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,242.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,183.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,217.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,217.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,238.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,178.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,218.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,247.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,256.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,261.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,175.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,242.55,
Mammography of both breasts-2 or more views,4517067,CDM,403,RC,,,outpatient,,,300.5,150.25,,291.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,180.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,270.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,270.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,180.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,205.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,180.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,242.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,266.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,199.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,243.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,276.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,285.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,291.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,195.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,180.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,270.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,180.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,180.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,270.45,
MM PLACEMENT OF CLIP W GUIDANCE BIL,4519081,CDM,401,RC,,,outpatient,,,1804.25,902.13,,1750.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,1082.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,579.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1623.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,1623.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,1082.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1312.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1231.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1082.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1456.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1456.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1598.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1196.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1461.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1659.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,1714.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,1750.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,1172.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,1082.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1082.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1082.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1623.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,1082.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1082.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1623.83,
MM PLACEMENT OF CLIP W GUID BIL EA  ADD,4519082,CDM,401,RC,,,outpatient,,,1654.25,827.13,,1604.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,992.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,466.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1488.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,1488.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,992.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1203.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1129.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,992.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1335.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1335.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1465.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1096.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1339.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1521.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,1571.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,1604.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,1075.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,992.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,992.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,992.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1488.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,992.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,992.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1488.83,
US BREAST BX BIL,4519083,CDM,402,RC,,,outpatient,,,1824.75,912.38,,1770.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,1094.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,566.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1642.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1642.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1094.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1327.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1245.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1094.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1472.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1472.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1616.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1209.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1478.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1678.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,1733.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,1770.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,1186.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,1094.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1094.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1094.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1642.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1094.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1094.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1642.28,
US BREAST BX BIL EA ADD,4519084,CDM,402,RC,,,outpatient,,,1644.75,822.38,,1595.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,986.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,448.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1480.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1480.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,986.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1196.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1122.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,986.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1327.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1327.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1457.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1090.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1332.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1513.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,1562.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,1595.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,1069.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,986.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,986.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,986.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1480.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,986.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,986.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1480.28,
MM PLACE CLIP PERCU BIL,4519281,CDM,401,RC,,,outpatient,,,531.5,265.75,,515.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,318.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,478.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,478.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,318.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,386.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,362.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,318.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,429.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,429.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,470.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,352.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,430.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,488.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,504.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,515.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,345.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,318.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,318.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,318.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,478.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,318.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,318.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,478.35,
MM PLACE CLIP PERCU BIL EA ADD,4519282,CDM,401,RC,,,outpatient,,,440.25,220.13,,427.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,264.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,396.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,396.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,264.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,300.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,264.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,355.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,355.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,390.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,291.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,356.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,405.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,418.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,427.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,286.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,264.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,264.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,264.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,396.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,264.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,264.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,396.23,
NM BONE IMAGING LIMITED,4520004,CDM,341,RC,,,outpatient,,,784.5,392.25,,760.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,470.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.65,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,706.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,706.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,470.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,570.8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,535.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,470.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,633.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,633.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,695.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,520.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,635.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,721.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,745.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,760.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,509.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,470.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,470.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,470.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,706.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,470.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,470.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,706.05,
NM LIVER / SPLEEN,4520006,CDM,341,RC,,,outpatient,,,855.75,427.88,,830.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,513.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,770.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,770.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,513.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,622.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,584.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,513.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,690.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,690.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,758.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,567.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,693.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,787.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,812.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,830.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,556.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,513.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,513.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,513.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,770.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,513.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,513.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,770.18,
NM LUNG SCAN PERFUSION,4520008,CDM,341,RC,,,outpatient,,,988.5,494.25,,958.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,593.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,889.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,889.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,593.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,719.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,674.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,593.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,797.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,797.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,875.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,655.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,800.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,909.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,939.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,958.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,642.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,593.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,593.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,593.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,889.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,593.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,593.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,889.65,
"A procedure most commonly ordered to detect areas of abnormal bone growth due to fractures, tumors, infection, or other bone issues",4520016,CDM,341,RC,,,outpatient,,,1189.25,594.63,,1153.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,713.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,266.32,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1070.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1070.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,713.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,865.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,811.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,713.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,959.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,959.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1053.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,788.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,963.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1094.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,1129.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,1153.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,773.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,713.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,713.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,713.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1070.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,713.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,713.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1070.33,
NM GI BLEED WITH RBC,4520018,CDM,341,RC,,,outpatient,,,1513.5,756.75,,1468.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,908.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,307.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1362.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,1362.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,908.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1101.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1032.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,908.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1221.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1221.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1341.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1003.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1225.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1392.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,1437.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,1468.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,983.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,908.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,908.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,908.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1362.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,908.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,908.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1362.15,
Image of the heart to assess perfusion,4520030,CDM,341,RC,,,outpatient,,,2595.75,1297.88,,2517.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,1557.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,417.38,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2336.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,2336.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1557.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1888.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1771.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1557.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2095.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2095.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2300.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1720.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2102.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2388.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,2465.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,2517.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,1687.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,1557.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1557.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1557.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2336.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1557.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1557.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2336.18,
NM REL SCAN FUNCTION/GFR,4520048,CDM,341,RC,,,outpatient,,,1174.25,587.13,,1139.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,704.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.45,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1056.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,1056.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,704.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,854.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,801.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,704.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,947.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,947.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1040.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,778.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,951.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1080.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,1115.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,1139.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,763.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,704.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,704.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,704.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1056.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,704.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,704.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1056.83,
NM BONE IMAGING 3 PHASE,4520050,CDM,341,RC,,,outpatient,,,1510.25,755.13,,1464.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,906.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,305.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1359.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,1359.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,906.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1098.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1030.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,906.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1219.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1219.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1338.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1001.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1223.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1389.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,1434.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,1464.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,981.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,906.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,906.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,906.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1359.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,906.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,906.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1359.23,
NM REL FUNCTION W DRUG,4520051,CDM,341,RC,,,outpatient,,,1037.5,518.75,,1006.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,622.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,933.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,933.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,622.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,754.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,708.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,622.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,837.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,837.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,919.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,687.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,840.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,954.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,985.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,1006.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,674.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,622.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,622.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,622.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,933.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,622.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,622.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,933.75,
NM REL FUNCTION W WO DRUG,4520052,CDM,341,RC,,,outpatient,,,1740.25,870.13,,1688.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,1044.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,326.3,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1566.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,1566.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,1044.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1266.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1187.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1044.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1404.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1404.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1542.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1153.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1409.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1601.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1653.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,1688.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,1131.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,1044.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1044.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1044.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1566.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,1044.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1044.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1566.23,
NM MYOCARDIAL SPECT SINGLE,4520054,CDM,341,RC,,,outpatient,,,1506.25,753.13,,1461.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,903.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,301.13,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1355.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,1355.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,903.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1095.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1028.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,903.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1215.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1215.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1334.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,998.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1220.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1385.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,1430.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,1461.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,979.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,903.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,903.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,903.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1355.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,903.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,903.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1355.63,
NM PARATHYROID IMAGING,4520062,CDM,341,RC,,,outpatient,,,775.75,387.88,,752.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,465.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,263.02,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,698.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,698.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,465.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,564.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,529.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,465.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,626.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,626.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,687.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,514.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,628.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,713.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,736.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,752.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,504.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,465.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,465.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,465.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,698.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,465.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,465.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,698.18,
NM GASTRIC EMPTYING STUDY,4520068,CDM,341,RC,,,outpatient,,,737.75,368.88,,715.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,442.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,294.28,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,663.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,663.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,442.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,536.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,503.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,442.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,595.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,595.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,653.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,489.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,597.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,678.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,700.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,715.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,479.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,442.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,442.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,442.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,663.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,442.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,442.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,663.98,
NM ULTRA TAG RBC COLD KIT up to 30 MCI,4520073,CDM,343,RC,,,outpatient,,,249.25,124.63,,241.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,224.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,170.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,201.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,220.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,165.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,201.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,229.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,236.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,241.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,162.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,224.33,
NM TC 99M SULFUR COLLOID up to 20MCI,4520074,CDM,343,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,90,
NM PYP COLD KIT up to 25 MCI,4520075,CDM,343,RC,,,outpatient,,,114.25,57.13,,110.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,102.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,102.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,75.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,92.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,105.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,108.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,110.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.83,
NM TC 99M MDP up to 30 MCI units,4520076,CDM,343,RC,,,outpatient,,,82.75,41.38,,80.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,67.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,76.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,90,
NM TC 99M CHOLETEC up to 15 MCI units,4520077,CDM,343,RC,,,outpatient,,,147.75,73.88,,143.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,132.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,100.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,88.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,97.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,119.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,135.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,140.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,143.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,88.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,88.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,132.98,
NM TC 99M MAA,4520078,CDM,343,RC,,,outpatient,,,82.75,41.38,,80.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.6,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,67.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,76.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,90,
NM TC 99M CARDIOLITE,4520079,CDM,343,RC,,,outpatient,,,312.5,156.25,,303.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,187.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,281.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,281.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,213.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,187.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,252.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,276.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,207.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,253.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,287.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,296.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,303.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,203.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,187.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,281.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,187.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,281.25,
NM TC 99M DTPA REL up to 25 MCI units,4520080,CDM,343,RC,,,outpatient,,,82.75,41.38,,80.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,67.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,76.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,90,
NM TC 99M DTPA PULMON up to 75 MCI units,4520081,CDM,343,RC,,,outpatient,,,124.75,62.38,,121.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.57,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,85.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,82.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,101.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,114.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,118.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,121.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,112.28,
NM I-123 CAPS (200 UCI),4520083,CDM,343,RC,,,outpatient,,,161,80.5,,156.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,144.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,144.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,109.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,129.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,106.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,130.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,148.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,152.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,156.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,144.9,
NM I-123 CAPS (100 UCI),4520084,CDM,343,RC,,,outpatient,,,117.25,58.63,,113.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,105.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,80.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,107.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,111.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,105.53,
NM TC 99M HMDP up to30 MCI units,4520086,CDM,343,RC,,,outpatient,,,82.75,41.38,,80.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,67.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,76.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,78.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.65,90,
NM THALLIUM 5MCI,4520089,CDM,343,RC,,,outpatient,,,383.75,191.88,,372.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,230.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,345.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,345.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,230.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,279.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,261.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,230.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,309.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,309.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,340.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,254.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,310.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,353.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,364.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,372.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,249.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,230.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,230.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,230.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,345.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,230.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,230.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,345.38,
NM ISOTOPE SESTAMIBI,4520099,CDM,343,RC,,,outpatient,,,301.75,150.88,,292.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,271.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,271.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,219.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,205.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,267.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,200.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,244.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,277.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,286.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,292.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,196.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,271.58,
NM HEPATOBILIARY SYS W GALLBLADDER,4520103,CDM,341,RC,,,outpatient,,,1286.75,643.38,,1248.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,772.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,290.14,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1158.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,1158.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,772.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,936.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,878.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,772.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1038.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1038.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1140.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,853.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1042.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1183.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,1222.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,1248.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,836.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,772.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,772.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,772.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1158.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,772.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,772.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1158.08,
NM HEPATOBILIARY SYS W GALLBLADDER W PH,4520104,CDM,341,RC,,,outpatient,,,1353.75,676.88,,1313.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,812.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,391.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1218.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,1218.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,812.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,984.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,923.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,812.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1092.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1092.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1199.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,897.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1096.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1245.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,1286.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,1313.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,879.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,812.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,812.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,812.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1218.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,812.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,812.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1218.38,
NM TC 99M DISOFENIN VIAL up to 15 MCI,4520140,CDM,343,RC,,,outpatient,,,301.75,150.88,,292.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,271.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,271.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,219.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,205.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,267.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,200.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,244.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,277.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,286.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,292.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,196.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,181.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,271.58,
NM CARDIAC POOL /FIRST PASS,4520142,CDM,341,RC,,,outpatient,,,1219.25,609.63,,1182.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,731.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.57,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1097.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1097.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,731.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,887.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,832.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,731.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,984.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,984.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1080.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,808.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,987.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1121.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,1158.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,1182.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,792.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,731.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,731.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,731.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1097.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,731.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,731.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1097.33,
NM MUGA,4520148,CDM,341,RC,,,outpatient,,,1338.5,669.25,,1298.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,803.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1204.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,1204.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,803.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,973.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,913.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,803.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1080.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1080.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1186.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,887.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1084.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1231.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,1271.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,1298.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,870.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,803.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,803.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,803.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1204.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,803.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,803.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1204.65,
NM PULMORY VENT & PERFUSION,4520208,CDM,341,RC,,,outpatient,,,250,125,,242.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,150,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,295.69,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,225,90,,,percent of total billed charges,Pays at 90% of total billed charges,225,90,,,percent of total billed charges,Pays at 90% of total billed charges,150,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,170.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,150,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,201.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,165.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,202.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,230,92,,,percent of total billed charges,Pays at 92% of total billed charges,237.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,242.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,162.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,150,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,225,90,,,percent of total billed charges,Pays at 90% of total billed charges,150,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,150,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,225,
NM PULMORY VENTILATION IMAGING,4520210,CDM,341,RC,,,outpatient,,,142.75,71.38,,138.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.64,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,128.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,97.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,94.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,115.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,131.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,135.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,138.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,92.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,85.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,128.48,
XR FLUORO ARTHROCENTESI ASP INJ MAJOR JT,4520611,CDM,940,RC,,,outpatient,,,143.25,71.63,,138.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,128.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,97.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,94.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,116.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,131.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,136.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,138.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,85.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,128.93,
NM SINCALIDE (KINEVAC) INJ : 5 MCG,4521100,CDM,250,RC,,,outpatient,,,226,113,,219.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,203.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,154.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,183.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,207.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,214.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,219.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,203.4,
NM PARATHYROID PLAR IMAGING W SPECT,4528071,CDM,341,RC,,,outpatient,,,1267.25,633.63,,1229.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,760.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,315.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1140.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,1140.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,760.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,922.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,864.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,760.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1022.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1022.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1122.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,840.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1026.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1165.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,1203.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,1229.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,823.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,760.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,760.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,760.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1140.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,760.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,760.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1140.53,
MM PLACEMENT OF CLIP W GUIDANCE LT,4529081,CDM,401,RC,,,outpatient,,,902.75,451.38,,875.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,541.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,579.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,812.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,812.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,541.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,656.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,616.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,541.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,728.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,728.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,799.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,598.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,731.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,830.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,857.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,875.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,586.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,541.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,541.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,541.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,812.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,541.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,541.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,812.48,
MM PLACEMENT OF CLIP W GUID LT EA  ADD,4529082,CDM,401,RC,,,outpatient,,,827,413.5,,802.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,496.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,466.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,744.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,744.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,496.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,601.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,564.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,496.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,667.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,667.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,732.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,548.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,669.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,760.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,785.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,802.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,537.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,496.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,496.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,496.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,744.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,496.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,496.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,744.3,
US BREAST BX LT,4529083,CDM,402,RC,,,outpatient,,,913.25,456.63,,885.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,547.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,566.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,821.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,821.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,547.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,664.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,623.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,547.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,737.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,737.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,809.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,605.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,739.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,840.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,867.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,885.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,593.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,547.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,547.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,547.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,821.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,547.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,547.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,821.93,
US BREAST BX LT EA ADD,4529084,CDM,402,RC,,,outpatient,,,822.75,411.38,,798.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,493.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,448.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,740.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,740.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,493.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,598.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,561.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,493.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,664.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,664.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,729.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,545.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,666.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,756.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,781.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,798.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,534.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,493.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,493.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,493.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,740.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,493.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,493.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,740.48,
MM PLACE CLIP PERCU LT,4529281,CDM,401,RC,,,outpatient,,,266,133,,258.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,159.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,239.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,239.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.54,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,181.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,159.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,214.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,235.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,176.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,215.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,244.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,252.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,258.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,172.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,159.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,239.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,159.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,239.4,
MM PLACE CLIP PERCU LT EA ADD,4529282,CDM,401,RC,,,outpatient,,,220.25,110.13,,213.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,198.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,150.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,177.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,195.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,146.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,178.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,202.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,209.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,213.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,143.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,132.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,198.23,
US PLACEMENT OF CLIP PERCU W GUID LT,4529285,CDM,361,RC,,,outpatient,,,687.5,343.75,,666.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,412.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,428.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,618.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,618.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,412.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,500.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,469.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,412.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,554.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,554.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,609.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,455.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,556.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,632.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,653.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,666.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,446.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,412.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,412.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,412.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,618.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,412.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,412.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,618.75,
US PLACE OF CLIP PERCU W GUID LT EA ADD,4529286,CDM,402,RC,,,outpatient,,,627.25,313.63,,608.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,376.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,366.18,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,564.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,564.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,376.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,456.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,428.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,376.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,506.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,506.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,555.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,415.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,508.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,577.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,595.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,608.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,407.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,376.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,376.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,376.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,564.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,376.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,376.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,564.53,
NM INJ RADIOACTIVE TRACER FOR SENTINEL N,4538792,CDM,761,RC,,,outpatient,,,34.75,17.38,,33.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.35,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,31.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.85,102.86,
US GUIDED LIVER BIOPSY,4547000,CDM,320,RC,,,outpatient,,,712.25,356.13,,690.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,427.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,274.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,641.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,641.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,427.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,518.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,486.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,427.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,574.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,574.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,631.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,472.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,576.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,655.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,676.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,690.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,462.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,427.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,427.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,427.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,641.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,427.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,427.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,641.03,
US THORACENTESIS ASP W IMAGING GUIDANCE,4547001,CDM,402,RC,,,outpatient,,,275.75,137.88,,267.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,165.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,248.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,248.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,188.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,165.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,222.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,244.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,223.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,253.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,267.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,179.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,165.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,248.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,165.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,248.18,
US GUIDED PARACENTESIS,4549083,CDM,402,RC,,,outpatient,,,409.25,204.63,,396.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,245.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.02,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,368.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,368.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,245.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,279.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,245.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,330.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,330.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,362.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,271.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,331.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,376.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,388.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,396.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,266.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,245.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,245.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,245.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,368.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,245.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,245.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,368.33,
US CYST ASP BREAST RT,4569000,CDM,510,RC,,,outpatient,,,380.75,190.38,,369.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,228.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.38,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,342.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,342.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,228.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,277.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,259.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,228.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,307.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,307.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,337.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,252.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,308.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,350.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,361.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,369.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,247.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,228.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,228.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,228.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,342.68,
US PLACEMENT NEEDLE LOC WIRE RT,4569290,CDM,361,RC,,,outpatient,,,579.25,289.63,,561.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,347.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,428.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,521.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,521.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,347.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,395.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,347.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,467.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,467.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,513.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,384.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,469.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,532.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,550.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,561.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,376.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,347.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,347.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,347.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,521.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,347.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,347.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,521.33,
3 views,4570047,CDM,324,RC,,,outpatient,,,164.25,82.13,,159.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,147.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,147.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,112.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,145.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,108.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,133.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,151.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,156.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,159.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,147.83,
XR TMJ BILAT,4570330,CDM,320,RC,,,outpatient,,,294.25,147.13,,285.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,176.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.15,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,264.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,264.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,176.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,200.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,176.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,237.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,237.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,260.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,195.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,238.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,270.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,279.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,285.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,191.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,176.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,264.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,176.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,176.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,264.83,
CT scan head or brain without dye,4570450,CDM,351,RC,,,outpatient,,,1125.75,562.88,,1091.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,675.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1013.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1013.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,675.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,819.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,768.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,675.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,908.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,908.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,997.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,746.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,911.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1035.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,1069.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,1091.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,731.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,675.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,675.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,675.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1013.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,675.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,675.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1013.18,
CT TEMPORAL BONE IAMS W/O CONTRAST,4570480,CDM,351,RC,,,outpatient,,,1547.5,773.75,,1501.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,928.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1392.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,1392.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,928.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1125.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1056.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,928.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1249.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1249.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1371.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1025.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1253.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1423.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,1470.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,1501.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,1005.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,928.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,928.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,928.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1392.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,928.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,928.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1392.75,
CT TEMPORAL BONE IAMS W CONTRAST,4570481,CDM,351,RC,,,outpatient,,,1805.75,902.88,,1751.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,1083.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1625.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1625.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1083.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1313.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1232.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1083.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1457.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1457.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1600.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1197.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1462.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1661.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,1715.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,1751.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,1173.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,1083.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1083.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1083.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1625.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,1083.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1083.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1625.18,
CT TEMPORAL BONE IAMS W WO CONTRAST,4570482,CDM,351,RC,,,outpatient,,,2098.25,1049.13,,2035.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,1258.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1888.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,1888.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,1258.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1526.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1432.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1258.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1693.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1693.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1859.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1391.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1699.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1930.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,1993.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,2035.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,1363.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,1258.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1258.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1258.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1888.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,1258.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1258.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1888.43,
CTA HEAD W AND WO CONTRAST,4570496,CDM,351,RC,,,outpatient,,,4154.5,2077.25,,4029.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,2492.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3739.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,3739.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,2492.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3022.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2835.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2492.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3353.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3353.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3681.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2754.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3365.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3822.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,3946.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,4029.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,2700.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,2492.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2492.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2492.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3739.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,2492.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,2492.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3739.05,
CTA NECK WITH CONTRAST,4570498,CDM,351,RC,,,outpatient,,,2586.5,1293.25,,2508.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1551.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2327.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,2327.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,1551.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1881.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1765.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1551.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2087.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2087.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2291.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1714.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2095.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2379.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,2457.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,2508.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,1681.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,1551.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1551.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1551.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2327.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,1551.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1551.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2327.85,
3 views,4571007,CDM,324,RC,,,outpatient,,,164.25,82.13,,159.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,147.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,147.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,112.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,145.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,108.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,133.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,151.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,156.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,159.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,147.83,
Single view,4571045,CDM,320,RC,,,outpatient,,,126.5,63.25,,122.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.18,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,113.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,86.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,75.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,83.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,102.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,116.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,120.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,122.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,75.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,75.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,113.85,
3 views,4571047,CDM,324,RC,,,outpatient,,,164.25,82.13,,159.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,147.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,147.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,112.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,145.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,108.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,133.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,151.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,156.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,159.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,98.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,147.83,
4 or more views,4571048,CDM,324,RC,,,outpatient,,,259.5,129.75,,251.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,233.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,233.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,177.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,209.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,229.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,172.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,210.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,238.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,246.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,251.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,233.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,233.55,
Diagnostic Radiology (Diagnostic Imaging) Procedures of the Chest,4571275,CDM,352,RC,,,outpatient,,,2977,1488.5,,2887.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,1786.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,256.3,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2679.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,2679.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1786.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2166.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2031.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1786.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2403.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2403.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2637.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1973.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2411.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2738.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,2828.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,2887.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,1935.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,1786.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1786.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1786.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2679.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1786.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1786.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2679.3,
XR SHOULDER 1V LEFT,4573020,CDM,320,RC,,,outpatient,,,121.5,60.75,,117.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.13,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,109.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,98.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,111.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,115.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,117.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,109.35,
XR SHOULDER ARTHROGRAPHY W SUPERV RT,4573040,CDM,320,RC,,,outpatient,,,269.5,134.75,,261.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.79,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,242.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,242.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,183.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,217.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,217.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,238.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,178.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,218.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,247.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,256.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,261.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,175.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,161.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,242.55,
Radiologic examition of the knee with 3 views,4573562,CDM,320,RC,,,outpatient,,,167.75,83.88,,162.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.66,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,150.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,111.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,154.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,159.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,100.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.98,
XR ABDOMEN SUP W/BILAT DECUBS,4574021,CDM,320,RC,,,outpatient,,,197.25,98.63,,191.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.66,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,177.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,177.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,134.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,159.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,130.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,159.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,181.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,187.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,191.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,128.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,118.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,177.53,
CTA  ABD PEL W CONT AND OR WO,4574174,CDM,352,RC,,,outpatient,,,4154.5,2077.25,,4029.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,2492.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,347.64,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3739.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,3739.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,2492.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3022.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2835.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2492.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3353.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3353.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3681.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2754.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3365.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3822.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,3946.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,4029.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,2700.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,2492.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2492.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2492.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3739.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,2492.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,2492.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,3739.05,
XR SMALL INTESTINE FOLLOW THROUGH STUDY,4574248,CDM,320,RC,,,outpatient,,,246,123,,238.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,147.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,221.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,221.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,147.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,167.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,147.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,198.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,217.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,163.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,199.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,226.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,233.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,238.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,159.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,147.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,147.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,147.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,221.4,
CTA  ABD AORTA BILAT ILEOFEM LE RUNOFF,4575635,CDM,352,RC,,,outpatient,,,2002,1001,,1941.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,1201.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,283.18,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1801.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1801.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1201.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1456.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1366.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1201.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1616.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1616.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1773.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1327.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1621.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1841.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,1901.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,1941.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,1301.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,1201.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1201.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1201.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1801.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,1201.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1201.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1801.8,
XR FISTULA SINUS TRACT STUDY,4576080,CDM,320,RC,,,outpatient,,,108,54,,104.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.55,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,97.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,95.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,71.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,87.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,99.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,102.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,104.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
MM RADIOLOGY EXAM SURGICAL SPEC-BREAST,4576098,CDM,401,RC,,,outpatient,,,88,44,,85.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.19,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,79.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.8,102.86,
XR DEXA BODY COMPOSITON STUDY 1 OR MORE,4576499,CDM,320,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,90,
US BREAST UNILATERAL COMPLETE,4576641,CDM,402,RC,,,outpatient,,,419.25,209.63,,406.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,251.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,377.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,377.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,251.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,305.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,286.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,251.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,338.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,338.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,371.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,277.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,339.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,385.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,398.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,406.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,272.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,251.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,377.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,251.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,251.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,377.33,
Limited ultrasound of the breast,4576642,CDM,402,RC,,,outpatient,,,334.5,167.25,,324.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,200.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.17,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,301.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,301.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,228.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,200.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,270.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,270.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,296.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,221.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,270.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,307.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,317.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,324.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,217.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,200.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,301.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,200.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,200.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,301.05,
"Diagnostic ultrasound of an extremity excluding the bone, joints or vessels",4576882,CDM,402,RC,,,outpatient,,,569.25,284.63,,552.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,341.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.6,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,512.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,512.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,341.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,414.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,388.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,341.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,459.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,459.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,504.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,377.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,461.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,523.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,540.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,552.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,370.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,341.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,341.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,341.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,512.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,341.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,341.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,512.33,
XR FLUOROSCOPIC GUIDANCE FOR PORT PLACEM,4577001,CDM,320,RC,,,outpatient,,,430.75,215.38,,417.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,258.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,387.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,387.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,258.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,293.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,258.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,347.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,347.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,381.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,285.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,348.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,396.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,409.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,417.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,279.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,258.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,258.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,258.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,387.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,258.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,258.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,387.68,
CT GUIDED NEEDLE BIOPSY / ASPIRATION,4577012,CDM,352,RC,,,outpatient,,,1308.5,654.25,,1269.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,785.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1177.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,1177.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,785.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,952.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,893.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,785.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1056.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1056.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1159.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,867.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1059.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1203.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,1243.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,1269.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,850.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,785.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,785.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,785.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1177.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,785.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,785.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1177.65,
"Diagnostic mammography, including computer-aided detection (cad) when performed; unilateral",4577065,CDM,401,RC,,,outpatient,,,356.25,178.13,,345.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,320.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,243.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,315.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,236.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,288.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,327.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,338.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,345.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,231.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,320.63,
"Diagnostic mammography, including computer-aided detection (cad) when performed; bilateral",4577066,CDM,401,RC,,,outpatient,,,466.25,233.13,,452.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,279.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.98,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,419.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,419.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,279.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,339.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,318.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,279.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,376.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,376.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,413.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,309.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,377.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,428.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,442.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,452.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,303.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,279.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,279.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,279.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,419.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,279.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,279.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,419.63,
Mammography of both breasts-2 or more views,4577067,CDM,403,RC,,,outpatient,,,417.25,208.63,,404.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,250.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,375.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,375.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,303.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,284.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,250.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,336.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,336.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,369.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,276.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,337.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,383.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,396.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,404.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,271.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,250.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,375.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,250.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,375.53,
XR LEG ALIGNMENT,4577077,CDM,320,RC,,,outpatient,,,136.5,68.25,,132.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.67,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,122.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,122.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,81.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,90.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,110.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,125.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,129.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,132.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,81.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,81.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,122.85,
Scan using a radioactive medication (radiopharmaceutical) to take pictures or images of the thyroid gland.,4578014,CDM,341,RC,,,outpatient,,,1039.25,519.63,,1008.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,623.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,211.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,935.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,935.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,623.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,756.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,709.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,623.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,838.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,838.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,920.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,689.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,841.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,956.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,987.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,1008.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,675.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,623.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,623.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,623.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,935.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,623.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,623.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,935.33,
Limited ultrasound of the breast,4590664,CDM,402,RC,,,outpatient,,,668,334,,647.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,400.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.17,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,601.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,601.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,486.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,455.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,400.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,539.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,539.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,591.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,442.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,541.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,614.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,634.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,647.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,434.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,400.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,601.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,400.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,400.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,601.2,
US ART DOP REL COMPLETE,4593975,CDM,921,RC,,,outpatient,,,675.25,337.63,,654.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,405.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,607.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,607.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,607.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,405.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,491.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,460.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,405.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,545.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,545.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,598.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,447.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,546.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,621.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,641.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,654.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,438.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,405.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,405.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,405.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,607.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,405.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,405.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,607.73,
US ART DOP REL LIMITED,4593976,CDM,921,RC,,,outpatient,,,374.5,187.25,,363.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,224.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,337.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,337.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,337.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,272.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,255.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,224.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,302.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,302.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,331.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,248.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,303.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,344.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,355.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,363.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,243.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,224.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,337.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,224.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,337.05,
IV INF/HYD INIT 31 - 60 MIN CT SCAN,4596360,CDM,260,RC,,,outpatient,,,226.25,113.13,,219.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,154.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,150,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,183.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,208.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,214.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,219.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,147.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,203.63,
IV HYD EA ADD HR >31 MIN CT SCAN,4596361,CDM,260,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
AEROSOL TREATMENT INT RESP,5000001,CDM,410,RC,,,outpatient,,,243.75,121.88,,236.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,219.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,219.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,166.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,146.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,196.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,215.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,161.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,197.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,224.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,231.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,236.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,158.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,146.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,219.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,146.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,219.38,
DEMONSTRATION AND/OR EVALUATION,5000002,CDM,410,RC,,,outpatient,,,85.5,42.75,,82.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.68,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,76.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,82.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,51.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.3,102.86,
CHEST PHYSIOTHER SUBSEQ,5000005,CDM,410,RC,,,outpatient,,,122.25,61.13,,118.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.16,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,110.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,99.02,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,118.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,73.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,110.03,
Test to determine how well oxygen moves from the lungs to the blood stream,5000017,CDM,460,RC,,,outpatient,,,248,124,,240.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,148.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,223.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,223.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,148.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,169.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,148.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,219.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,164.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,200.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,228.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,235.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,240.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,161.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,148.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,148.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,148.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,223.2,
Test to determine if wheezing is present,5000018,CDM,460,RC,,,outpatient,,,353.75,176.88,,343.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,212.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.52,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,318.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,318.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,212.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,257.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,241.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,212.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,285.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,285.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,313.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,234.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,286.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,325.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,336.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,343.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,229.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,212.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,318.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,212.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,212.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,318.38,
SOTRACHEAL SUCTION - ED,5000020,CDM,490,RC,,,outpatient,,,161,80.5,,156.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,144.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,144.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,109.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,129.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,106.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,130.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,148.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,152.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,156.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,144.9,
MDI INITIAL RESP,5000021,CDM,410,RC,,,outpatient,,,243.75,121.88,,236.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,219.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,219.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,166.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,146.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,196.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,215.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,161.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,197.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,224.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,231.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,236.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,158.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,146.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,219.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,146.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,219.38,
SOTRACHEAL SUCTION - FLOOR,5000022,CDM,410,RC,,,outpatient,,,161,80.5,,156.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,144.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,144.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,109.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,129.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,106.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,130.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,148.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,152.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,156.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,144.9,
ARTERIAL BLOOD GAS COLLE - ED,5000026,CDM,450,RC,,,outpatient,,,92.5,46.25,,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,74.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,102.86,
ARTERIAL BLOOD GAS COLLE (NOT ED),5000027,CDM,761,RC,,,outpatient,,,92.5,46.25,,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,74.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,102.86,
CHEST PHYSIOTHER INIT,5000029,CDM,410,RC,,,outpatient,,,158,79,,153.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.8,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,142.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,140,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,145.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,150.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,153.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,94.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,142.2,
SIX MINUTE WALK DISTANCE W/WO OXYGEN,5000038,CDM,460,RC,,,outpatient,,,149.25,74.63,,144.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.33,
EEG /AWAKE & ASLEEP,5000040,CDM,740,RC,,,outpatient,,,703.5,351.75,,682.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,422.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,372.64,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,633.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,633.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,422.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,511.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,480.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,422.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,567.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,567.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,623.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,466.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,569.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,647.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,668.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,682.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,457.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,422.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,422.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,422.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,633.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,422.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,422.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,633.15,
PULSE OX REST/EXER,5000043,CDM,460,RC,,,outpatient,,,112.25,56.13,,108.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,101.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,103.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
PULSE OX SINGLE,5000044,CDM,460,RC,,,outpatient,,,8,4,,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,102.86,
Test to determine how well oxygen moves from the lungs to the blood stream,5000045,CDM,460,RC,,,outpatient,,,115.5,57.75,,112.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,103.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.95,
CPAP/BIPAP,5000049,CDM,410,RC,,,outpatient,,,169.5,84.75,,164.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.55,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,152.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,115.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,112.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,137.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,155.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,161.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,164.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,110.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,152.55,
Test to measure how well gases diffuse across lung surfaces,5000050,CDM,460,RC,,,outpatient,,,214.5,107.25,,208.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,193.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,193.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,146.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,173.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,190.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,142.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,173.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,197.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,203.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,208.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,128.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,193.05,
PULSE OX CONTINUOUS,5000052,CDM,460,RC,,,outpatient,,,180,90,,174.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.65,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,162,90,,,percent of total billed charges,Pays at 90% of total billed charges,162,90,,,percent of total billed charges,Pays at 90% of total billed charges,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,122.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,145.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,159.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,119.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,145.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,165.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,171,95,,,percent of total billed charges,Pays at 95% of total billed charges,174.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,117,65,,,percent of total billed charges,Pays at 65% of total billed charges,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162,90,,,percent of total billed charges,Pays at 90% of total billed charges,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,162,
Measure of lung function and gas exchange,5000053,CDM,460,RC,,,outpatient,,,68.25,34.13,,66.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,45.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,55.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,62.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,66.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,102.86,
VENT /ASST & MGMT FIRST,5000059,CDM,410,RC,,,outpatient,,,312.75,156.38,,303.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,187.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,281.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,281.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,213.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,187.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,252.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,277.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,207.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,253.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,287.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,297.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,303.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,203.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,187.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,281.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,187.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,281.48,
VENT /ASST & MGMT SUBSEQ,5000060,CDM,410,RC,,,outpatient,,,458.25,229.13,,444.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,274.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.83,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,412.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,412.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,274.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,333.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,312.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,274.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,369.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,369.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,406.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,303.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,371.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,421.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,435.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,444.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,297.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,274.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,274.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,274.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,412.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,274.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,274.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,412.43,
EEG 41-60 MINUTES AWAKE,5000067,CDM,740,RC,,,outpatient,,,702.25,351.13,,681.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,421.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,284.86,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,632.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,632.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,421.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,510.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,479.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,421.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,566.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,566.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,622.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,465.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,568.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,646.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,667.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,681.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,456.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,421.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,632.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,421.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,421.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,632.03,
EEG 61-119 MINUTES AWAKE,5000068,CDM,740,RC,,,outpatient,,,838.25,419.13,,813.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,502.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,355.75,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,754.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,754.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,502.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,609.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,572.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,502.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,676.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,676.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,742.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,555.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,678.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,771.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,796.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,813.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,544.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,502.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,502.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,502.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,754.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,502.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,502.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,754.43,
Test to determine how well oxygen moves from the lungs to the blood stream,5000075,CDM,460,RC,,,outpatient,,,115.5,57.75,,112.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,103.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.95,
METHACHOLINE CHALLENGE,5000078,CDM,460,RC,,,outpatient,,,728.5,364.25,,706.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,437.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.8,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,655.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,655.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,437.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,530.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,497.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,437.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,588.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,588.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,645.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,483,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,590.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,670.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,692.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,706.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,473.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,437.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,437.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,437.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,655.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,437.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,437.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,655.65,
EMERGENCY INTUBATION,5000084,CDM,450,RC,,,outpatient,,,460.75,230.38,,446.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,276.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,414.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,414.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,276.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,335.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,314.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,276.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,371.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,371.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,408.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,305.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,373.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,423.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,437.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,446.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,299.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,276.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,276.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,276.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,414.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,276.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,276.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,414.68,
EEG /AWAKE & DROWSY,5000220,CDM,740,RC,,,outpatient,,,546.5,273.25,,530.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,327.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,317.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,491.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,491.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,327.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,397.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,372.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,327.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,441.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,441.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,484.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,362.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,442.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,502.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,519.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,530.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,355.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,327.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,327.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,327.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,491.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,327.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,327.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,491.85,
STRESS TEST TRACING ONLY,5000900,CDM,482,RC,,,outpatient,,,959,479.5,,930.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,575.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,863.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,863.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,863.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,575.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,697.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,654.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,575.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,774.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,774.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,849.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,635.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,776.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,882.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,911.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,930.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,623.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,575.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,575.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,575.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,863.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,575.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,575.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,863.1,
CPR (NOT ED),5092950,CDM,410,RC,,,outpatient,,,715.5,357.75,,694.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,429.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,295.77,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,643.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,643.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,429.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,520.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,488.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,429.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,577.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,577.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,634,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,474.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,579.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,658.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,679.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,694.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,465.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,429.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,429.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,429.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,643.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,429.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,429.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,643.95,
Graphical representation of inspiration and expiration,5094375,CDM,460,RC,,,outpatient,,,103.25,51.63,,100.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.78,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,92.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,70.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,61.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,68.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,94.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,98.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,100.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,61.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,61.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
VEST CHEST PHYSIOTHERAPY PER SESSION,5094669,CDM,410,RC,,,outpatient,,,183.5,91.75,,178,97,,,percent of total billed charges,Pays at 97% of total billed charges,110.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.71,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,165.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,125.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,110.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,148.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,168.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,174.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,178,97,,,percent of total billed charges,Pays at 97% of total billed charges,119.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,110.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,110.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,165.15,
Measures how much air is in the lungs after taking a deep breath,5094726,CDM,460,RC,,,outpatient,,,79.75,39.88,,77.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,71.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.85,102.86,
Measure of lung function and gas exchange,5094727,CDM,460,RC,,,outpatient,,,236.5,118.25,,229.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,141.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,212.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,212.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,161.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,141.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,190.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,209.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,156.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,191.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,217.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,224.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,229.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,153.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,141.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,141.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,212.85,
PR PHASE IV,5200005,CDM,948,RC,,,outpatient,,,30,15,,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9,30,,,percent of total billed charges,Pays at 30% of total billed charges,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,27.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,90,
PR THERAPEUTIC PROC STRENGTH ENDUR 15 MI,5200237,CDM,948,RC,,,outpatient,,,54.25,27.13,,52.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,48.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,43.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,49.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,51.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,52.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.55,90,
PR THERAPEUTIC PROC RESP FUNCT 15 MIN,5200238,CDM,948,RC,,,outpatient,,,58.75,29.38,,56.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,52.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,40.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,47.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,54.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,55.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,56.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,35.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.25,90,
PR THERAPEUTIC PROC RESP FUNCT GROUP,5200239,CDM,948,RC,,,outpatient,,,44.75,22.38,,43.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.75,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,40.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,41.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,42.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,43.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.85,90,
PR EXERCISE COPD 1 HR/SESSION,5200424,CDM,948,RC,,,outpatient,,,56.25,28.13,,54.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,50.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,45.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,51.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,53.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,90,
PR SIX MINUTE WALK DISTANCE W/WO OXYGEN,5294618,CDM,460,RC,,,outpatient,,,149.25,74.63,,144.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.33,
PR DEMONSTRATION AND/OR EVALUATION,5294664,CDM,410,RC,,,outpatient,,,85.5,42.75,,82.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.68,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,76.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,82.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,51.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.3,102.86,
CR PHASE III,5300005,CDM,943,RC,,,outpatient,,,30,15,,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9,30,,,percent of total billed charges,Pays at 30% of total billed charges,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,27.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,90,
Use of EKG to monitor cardiac rehabilitation,5303798,CDM,943,RC,,,outpatient,,,240.25,120.13,,233.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,144.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.52,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,216.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,216.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,144.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,163.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,144.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,193.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,212.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,159.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,194.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,221.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,228.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,233.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,156.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,144.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,216.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,144.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,144.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,216.23,
CARDIAC REHAB W/O CONT ECG,5393797,CDM,943,RC,,,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,8.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,102.86,100,,,Case rate,pays at 100% of fixed rate,,,,,Other,Not Separately reimbursable,100,102.86,
Use of EKG to monitor cardiac rehabilitation,5393798,CDM,943,RC,,,outpatient,,,240.25,120.13,,233.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,144.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.52,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,216.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,216.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,144.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,163.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,144.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,193.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,212.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,159.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,194.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,221.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,228.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,233.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,156.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,144.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,216.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,144.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,144.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,216.23,
PT CONTRAST BATHS 15MIN,5500002,CDM,420,RC,,,outpatient,,,55.75,27.88,,54.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.8,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,50.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,45.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,51.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,52.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,33.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.45,102.86,
Repeated application to one or more parts of the body,5500004,CDM,420,RC,,,outpatient,,,63.75,31.88,,61.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,57.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,51.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,58.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,60.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,61.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.25,102.86,
One time use uttended,5500005,CDM,420,RC,,,outpatient,,,73.25,36.63,,71.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.35,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,49.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,59.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,48.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,59.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,67.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,69.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,71.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,102.86,
"Incorporates the use of multiple parameters, such as balance, strength, and range of motion, for a functiol activity",5500007,CDM,420,RC,,,outpatient,,,115,57.5,,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,105.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.5,
A type of physical therapy,5500008,CDM,420,RC,,,outpatient,,,95,47.5,,92.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,85.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,64.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,62.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,76.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,87.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,90.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,92.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57,102.86,
Manipulation of 1 or more regions of the body,5500012,CDM,420,RC,,,outpatient,,,101.5,50.75,,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,82.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,93.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
A technique used by physical therapists to restore normal body movement patterns,5500016,CDM,420,RC,,,outpatient,,,113.25,56.63,,109.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,101.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,75.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,104.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,107.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,109.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
PT ORTHOT/PROST MNGT/TRAIN SUBSQ EA 15 M,5500017,CDM,421,RC,,,outpatient,,,125.75,62.88,,121.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.02,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,113.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,85.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,111.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,83.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,101.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,115.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,119.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,121.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,113.18,
PT PARAFFIN BATH,5500019,CDM,420,RC,,,outpatient,,,115.25,57.63,,111.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.73,
Form of decompression therapy of the spine,5500023,CDM,420,RC,,,outpatient,,,56.5,28.25,,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,45.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,51.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,53.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,102.86,
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",5500025,CDM,420,RC,,,outpatient,,,109,54.5,,105.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,74.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,72.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,88.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,100.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,103.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,105.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Use of sound waves to treat medical problems, especially musculoskeletal problems like inflammation from injuries",5500026,CDM,420,RC,,,outpatient,,,104,52,,100.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,93.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,93.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,70.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,68.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,84.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,95.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,98.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,100.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Machines designed to pump cold water into an inflatable wrap or brace, compressing the enveloped area of the body",5500029,CDM,420,RC,,,outpatient,,,58.5,29.25,,56.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,52.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,47.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,53.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,55.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,56.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.1,102.86,
.WRAP AROUND KNEE ORTHOSES,5500031,CDM,271,RC,,,outpatient,,,127.5,63.75,,123.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,393.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,114.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,87.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,76.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,84.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,103.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,117.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,121.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,123.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,76.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,76.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,114.75,
.ANKLE BRACE XS,5500032,CDM,271,RC,,,outpatient,,,174.75,87.38,,169.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,157.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,119.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,115.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,141.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,160.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,166.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,169.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,157.28,
.CUSTOM ORTHOTICS,5500034,CDM,271,RC,,,outpatient,,,205,102.5,,198.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,123,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.38,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,184.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,184.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,123,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,139.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,123,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,165.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,181.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,135.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,166.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,188.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,194.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,198.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,133.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,123,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,123,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,123,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,184.5,
.DARCO BOOT  MED,5500036,CDM,271,RC,,,outpatient,,,20.5,10.25,,19.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.86,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,18.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,18.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.3,90,
.WEAR KNEE HIGH GARMENTS,5500037,CDM,271,RC,,,outpatient,,,91.25,45.63,,88.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,82.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,62.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,60.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,73.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,83.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,86.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,88.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,54.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,54.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.75,90,
PT ORTHO FIT/TRAIN EA 15 MIN INITIAL VIS,5500056,CDM,420,RC,,,outpatient,,,124.75,62.38,,121.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,85.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,82.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,101.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,114.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,118.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,121.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,112.28,
PT KX ORTHO FIT/TRAIN 15 MIN INIT ENC,5500057,CDM,420,RC,,,outpatient,,,124.75,62.38,,121.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,85.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,82.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,101.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,114.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,118.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,121.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,112.28,
Occupatiol therapy,5500062,CDM,420,RC,,,outpatient,,,116.25,58.13,,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,104.63,
PT THERAPEUTIC EXER /GROUP EA 15,5500066,CDM,420,RC,,,outpatient,,,69.5,34.75,,67.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.83,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,56.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,63.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,67.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,102.86,
PT WC MGMT TRAIN 15 MIN,5500072,CDM,420,RC,,,outpatient,,,106,53,,102.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.23,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,95.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,72.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,85.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,97.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,100.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,102.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Psychiatric treatment in which seizures are electrically induced in patients to provide relief from mental disorders,5500096,CDM,420,RC,,,outpatient,,,92.5,46.25,,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,74.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,102.86,
Use of water for therapy/exercises,5500112,CDM,420,RC,,,outpatient,,,131.5,65.75,,127.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,118.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,106.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,120.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,124.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,127.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,118.35,
One time use uttended,5500170,CDM,430,RC,,,outpatient,,,73.25,36.63,,71.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.35,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,49.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,59.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,48.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,59.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,67.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,69.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,71.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,102.86,
One time use uttended,5500171,CDM,430,RC,,,outpatient,,,73.25,36.63,,71.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.35,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,49.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,59.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,48.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,59.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,67.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,69.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,71.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,102.86,
"Use of sound waves to treat medical problems, especially musculoskeletal problems like inflammation from injuries",5500184,CDM,430,RC,,,outpatient,,,104,52,,100.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,93.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,93.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,70.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,68.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,84.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,95.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,98.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,100.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Use of sound waves to treat medical problems, especially musculoskeletal problems like inflammation from injuries",5500185,CDM,430,RC,,,outpatient,,,104,52,,100.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,93.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,93.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,70.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,68.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,84.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,95.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,98.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,100.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",5500186,CDM,430,RC,,,outpatient,,,109,54.5,,105.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,74.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,72.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,88.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,100.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,103.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,105.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",5500187,CDM,430,RC,,,outpatient,,,109,54.5,,105.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,74.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,72.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,88.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,100.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,103.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,105.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
A technique used by physical therapists to restore normal body movement patterns,5500188,CDM,430,RC,,,outpatient,,,113.25,56.63,,109.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,101.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,75.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,104.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,107.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,109.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
A technique used by physical therapists to restore normal body movement patterns,5500189,CDM,430,RC,,,outpatient,,,113.25,56.63,,109.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,101.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,75.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,104.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,107.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,109.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Manipulation of 1 or more regions of the body,5500194,CDM,430,RC,,,outpatient,,,101.5,50.75,,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,82.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,93.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Manipulation of 1 or more regions of the body,5500195,CDM,430,RC,,,outpatient,,,101.5,50.75,,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,82.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,93.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
OT THERAPEUTIC PROC GROUP,5500196,CDM,430,RC,,,outpatient,,,69.5,34.75,,67.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.83,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,56.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,63.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,67.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,102.86,
OT KX THERAPEUTIC PROC GROUP,5500197,CDM,430,RC,,,outpatient,,,69.5,34.75,,67.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.83,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,56.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,63.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,67.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,102.86,
"Incorporates the use of multiple parameters, such as balance, strength, and range of motion, for a functiol activity",5500198,CDM,430,RC,,,outpatient,,,115,57.5,,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,105.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.5,
"Incorporates the use of multiple parameters, such as balance, strength, and range of motion, for a functiol activity",5500199,CDM,430,RC,,,outpatient,,,115,57.5,,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,105.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.5,
OT SENSORY INTEGRATIVE TECH EA 15 MIN,5500202,CDM,430,RC,,,outpatient,,,100,50,,97,97,,,percent of total billed charges,Pays at 97% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.15,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,90,90,,,percent of total billed charges,Pays at 90% of total billed charges,90,90,,,percent of total billed charges,Pays at 90% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,68.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,66.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,92,92,,,percent of total billed charges,Pays at 92% of total billed charges,95,95,,,percent of total billed charges,Pays at 95% of total billed charges,97,97,,,percent of total billed charges,Pays at 97% of total billed charges,65,65,,,percent of total billed charges,Pays at 65% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90,90,,,percent of total billed charges,Pays at 90% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
OT KX SENSORY INTEGRATIVE TECH EA 15 MIN,5500203,CDM,430,RC,,,outpatient,,,100,50,,97,97,,,percent of total billed charges,Pays at 97% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.15,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,90,90,,,percent of total billed charges,Pays at 90% of total billed charges,90,90,,,percent of total billed charges,Pays at 90% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,68.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,66.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,92,92,,,percent of total billed charges,Pays at 92% of total billed charges,95,95,,,percent of total billed charges,Pays at 95% of total billed charges,97,97,,,percent of total billed charges,Pays at 97% of total billed charges,65,65,,,percent of total billed charges,Pays at 65% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90,90,,,percent of total billed charges,Pays at 90% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Occupatiol therapy,5500204,CDM,430,RC,,,outpatient,,,116.25,58.13,,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,104.63,
Occupatiol therapy,5500205,CDM,430,RC,,,outpatient,,,116.25,58.13,,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,104.63,
OT COMMUNITY WORK REINTEGRATION,5500206,CDM,430,RC,,,outpatient,,,104.5,52.25,,101.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.94,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,94.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,71.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,69.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,84.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,96.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,99.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,101.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,62.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
OT KX COMMUNITY WORK REINTEGRATION,5500207,CDM,430,RC,,,outpatient,,,104.5,52.25,,101.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.94,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,94.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,71.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,69.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,84.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,96.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,99.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,101.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,62.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
OT WHEELCHAIR MGMT EA 15 MIN,5500208,CDM,430,RC,,,outpatient,,,106,53,,102.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.23,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,95.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,72.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,85.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,97.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,100.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,102.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
OT KX WHEELCHAIR MGMT EA 15 MIN,5500209,CDM,430,RC,,,outpatient,,,106,53,,102.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.23,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,95.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,72.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,85.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,97.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,100.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,102.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
OT ORTHOTIC TRAIN & MGMT EA 15 MIN INIT,5500216,CDM,430,RC,,,outpatient,,,124.75,62.38,,121.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,85.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,82.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,101.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,114.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,118.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,121.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,112.28,
OT KX ORTHOTIC TRAIN & MGMT EA 15 INIT E,5500217,CDM,430,RC,,,outpatient,,,124.75,62.38,,121.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,85.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,82.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,101.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,114.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,118.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,121.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,112.28,
OT KX ORTH/PROS MNGT/TRAIN SUBSQ EA 15 M,5500221,CDM,430,RC,,,outpatient,,,125.75,62.88,,121.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.02,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,113.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,85.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,111.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,83.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,101.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,115.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,119.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,121.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,113.18,
ST MOD BARIUM SWALLOW,5500232,CDM,444,RC,,,outpatient,,,520,260,,504.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,312,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.19,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,468,90,,,percent of total billed charges,Pays at 90% of total billed charges,468,90,,,percent of total billed charges,Pays at 90% of total billed charges,312,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,378.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,354.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,312,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,419.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,419.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,460.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,344.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,421.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,478.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,494,95,,,percent of total billed charges,Pays at 95% of total billed charges,504.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,338,65,,,percent of total billed charges,Pays at 65% of total billed charges,312,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,312,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,312,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,468,90,,,percent of total billed charges,Pays at 90% of total billed charges,312,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,312,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,468,
PT MATERNITY PANTY HOSE,5500300,CDM,271,RC,,,outpatient,,,189.25,94.63,,183.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,170.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,170.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,129.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,113.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,167.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,125.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,153.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,174.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,179.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,183.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,123.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,113.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,113.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,170.33,
PT WORK CONDITIONING INITIAL 2 HOURS,5500302,CDM,420,RC,,,outpatient,,,270.25,135.13,,262.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.25,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,243.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,243.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,184.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,218.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,239.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,179.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,218.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,248.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,256.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,262.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,175.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,243.23,
PT WORK CONDITIONING EA ADD HOUR,5500314,CDM,420,RC,,,outpatient,,,108,54,,104.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,97.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,95.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,71.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,87.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,99.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,102.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,104.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Therapy for speech or hearing,5500411,CDM,441,RC,,,outpatient,,,71.5,35.75,,69.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,57.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,65.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,67.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,102.86,
Therapy for speech or hearing,5500412,CDM,441,RC,,,outpatient,,,139.75,69.88,,135.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,113.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,128.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,135.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,125.78,
Therapy for speech or hearing,5500413,CDM,441,RC,,,outpatient,,,208.5,104.25,,202.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,187.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,142.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,168.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,184.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,138.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,168.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,191.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,198.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,202.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,187.65,
Therapy for speech or hearing,5500414,CDM,441,RC,,,outpatient,,,277.75,138.88,,269.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,249.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,249.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,189.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,224.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,246.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,184.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,224.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,255.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,263.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,269.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,180.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,249.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,249.98,
Therapy for speech or hearing,5500415,CDM,441,RC,,,outpatient,,,345.25,172.63,,334.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,310.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,310.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,235.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,278.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,278.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,305.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,228.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,279.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,317.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,327.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,334.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,224.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,310.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,310.73,
Therapy for speech or hearing,5500416,CDM,441,RC,,,outpatient,,,412,206,,399.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,370.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,370.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,281.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,332.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,332.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,365.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,273.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,333.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,379.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,391.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,399.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,267.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,370.8,
Therapy for speech or hearing,5500417,CDM,441,RC,,,outpatient,,,479,239.5,,464.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,431.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,431.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,348.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,326.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,386.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,386.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,424.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,317.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,387.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,440.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,455.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,464.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,311.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,431.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,431.1,
Therapy for speech or hearing,5500418,CDM,441,RC,,,outpatient,,,548,274,,531.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,493.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,493.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,398.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,374.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,442.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,442.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,485.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,363.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,443.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,504.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,520.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,531.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,356.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,493.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,493.2,
ST SW EVAL 8-22 MIN,5500421,CDM,444,RC,,,outpatient,,,71.5,35.75,,69.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,57.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,65.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,67.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,102.86,
ST SW EVAL 23-37 MIN,5500422,CDM,444,RC,,,outpatient,,,139.75,69.88,,135.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,113.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,128.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,135.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,125.78,
ST SW EVAL 38-52 MIN,5500423,CDM,444,RC,,,outpatient,,,208.5,104.25,,202.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,187.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,142.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,168.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,184.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,138.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,168.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,191.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,198.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,202.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,187.65,
ST SW EVAL 53-67 MIN,5500424,CDM,444,RC,,,outpatient,,,277.75,138.88,,269.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,249.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,249.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,189.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,224.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,246.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,184.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,224.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,255.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,263.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,269.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,180.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,249.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,249.98,
ST SW EVAL 68-82 MIN,5500425,CDM,444,RC,,,outpatient,,,345.25,172.63,,334.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,310.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,310.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,235.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,278.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,278.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,305.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,228.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,279.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,317.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,327.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,334.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,224.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,310.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,310.73,
ST SW EVAL 83-97 MIN,5500426,CDM,444,RC,,,outpatient,,,412,206,,399.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,370.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,370.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,281.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,332.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,332.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,365.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,273.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,333.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,379.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,391.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,399.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,267.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,370.8,
ST SW EVAL 98-112 MIN,5500427,CDM,444,RC,,,outpatient,,,479,239.5,,464.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,431.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,431.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,348.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,326.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,386.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,386.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,424.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,317.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,387.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,440.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,455.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,464.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,311.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,431.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,431.1,
ST SW EVAL 113-127 MIN,5500428,CDM,444,RC,,,outpatient,,,548,274,,531.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,493.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,493.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,398.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,374.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,442.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,442.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,485.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,363.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,443.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,504.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,520.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,531.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,356.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,493.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,493.2,
ST SW TX 8 TO 22 MIN,5500431,CDM,441,RC,,,outpatient,,,58,29,,56.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,52.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,46.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,53.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,55.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,56.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.8,102.86,
ST SW TX 23 TO 37 MIN,5500432,CDM,441,RC,,,outpatient,,,169.5,84.75,,164.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,152.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,115.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,112.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,137.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,155.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,161.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,164.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,110.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,152.55,
ST SW TX 38 TO 52 MIN,5500433,CDM,441,RC,,,outpatient,,,225.75,112.88,,218.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,203.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,154.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,182.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,207.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,214.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,218.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,203.18,
ST SW TX 53 TO 67 MIN,5500434,CDM,441,RC,,,outpatient,,,282,141,,273.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,253.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,253.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,192.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,227.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,249.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,186.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,228.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,259.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,267.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,273.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,183.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,253.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,253.8,
ST SW TX 68 TO 82 MIN,5500435,CDM,441,RC,,,outpatient,,,338.25,169.13,,328.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,304.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,304.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,246.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,230.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,273.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,299.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,224.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,273.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,311.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,321.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,328.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,219.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,304.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,304.43,
ST SW TX 83 TO 97 MIN,5500436,CDM,441,RC,,,outpatient,,,396.75,198.38,,384.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,357.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,357.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,288.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,270.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,320.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,351.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,263.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,321.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,365.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,376.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,384.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,257.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,357.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,357.08,
ST SW TX 98 TO 112 MIN,5500437,CDM,441,RC,,,outpatient,,,455,227.5,,441.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,409.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,409.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,331.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,310.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,367.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,367.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,403.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,301.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,368.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,418.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,432.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,441.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,295.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,409.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,409.5,
ST SW TX 113 TO 127 MIN,5500438,CDM,441,RC,,,outpatient,,,513.25,256.63,,497.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,461.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,461.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,373.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,350.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,414.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,414.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,454.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,340.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,415.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,472.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,487.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,497.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,333.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,461.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,461.93,
ST FLUENCY EVAL 8-22 MIN,5500500,CDM,440,RC,,,outpatient,,,212,106,,205.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,190.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,190.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,144.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,171.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,187.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,140.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,171.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,195.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,201.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,205.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,137.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,190.8,
ST FLUENCY EVAL 23-37 MIN,5500501,CDM,440,RC,,,outpatient,,,266.25,133.13,,258.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,239.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,239.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,181.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,214.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,235.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,176.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,215.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,244.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,252.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,258.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,173.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,239.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,239.63,
ST FLUENCY EVAL 38-52 MIN,5500502,CDM,440,RC,,,outpatient,,,374.75,187.38,,363.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,337.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,337.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,272.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,255.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,302.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,302.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,332.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,248.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,303.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,344.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,356.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,363.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,243.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,337.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,337.28,
ST FLUENCY EVAL 53-67 MIN,5500503,CDM,440,RC,,,outpatient,,,538,269,,521.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,484.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,484.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,391.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,367.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,434.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,434.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,476.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,356.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,435.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,494.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,511.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,521.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,349.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,484.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,484.2,
ST FLUENCY EVAL 68-82 MIN,5500504,CDM,440,RC,,,outpatient,,,592.25,296.13,,574.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,355.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,533.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,533.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,355.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,430.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,404.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,355.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,478.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,478.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,524.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,392.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,479.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,544.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,562.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,574.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,384.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,355.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,355.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,355.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,533.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,355.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,355.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,533.03,
ST FLUENCY EVAL 83-97 MIN,5500505,CDM,440,RC,,,outpatient,,,700.75,350.38,,679.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,630.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,630.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,509.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,478.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,565.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,565.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,620.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,464.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,567.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,644.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,665.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,679.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,455.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,630.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,630.68,
ST FLUENCY EVAL 98-112 MIN,5500506,CDM,440,RC,,,outpatient,,,809,404.5,,784.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,485.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,728.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,728.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,485.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,588.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,552.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,485.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,653.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,653.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,716.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,536.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,655.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,744.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,768.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,784.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,525.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,485.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,728.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,485.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,485.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,728.1,
ST FLUENCY EVAL 113-127 MIN,5500507,CDM,440,RC,,,outpatient,,,917.75,458.88,,890.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,550.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,825.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,825.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,550.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,667.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,626.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,550.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,740.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,740.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,813.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,608.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,743.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,844.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,871.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,890.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,596.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,550.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,550.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,550.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,825.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,550.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,550.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,825.98,
ST SOUND EVAL 8-22 MIN,5500510,CDM,440,RC,,,outpatient,,,172.75,86.38,,167.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,155.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,117.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,153.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,139.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,158.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,164.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,167.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,103.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,155.48,
ST SOUND EVAL 23-37 MIN,5500511,CDM,440,RC,,,outpatient,,,227.25,113.63,,220.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,204.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,204.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,155.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,183.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,201.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,150.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,184.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,209.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,215.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,220.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,147.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,204.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,204.53,
ST SOUND EVAL 38-52 MIN,5500512,CDM,440,RC,,,outpatient,,,335.75,167.88,,325.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,302.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,302.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,244.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,229.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,271.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,297.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,222.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,271.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,308.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,318.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,325.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,218.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,302.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,302.18,
ST SOUND EVAL 53-67 MIN,5500513,CDM,440,RC,,,outpatient,,,498.25,249.13,,483.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,298.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,448.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,448.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,298.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,362.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,340.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,298.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,402.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,402.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,441.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,330.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,403.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,458.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,473.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,483.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,323.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,298.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,298.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,298.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,448.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,298.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,298.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,448.43,
ST SOUND EVAL 68-82 MIN,5500514,CDM,440,RC,,,outpatient,,,552.5,276.25,,535.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,497.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,497.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,402,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,377.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,445.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,445.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,489.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,366.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,447.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,508.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,524.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,535.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,359.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,497.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,497.25,
ST SOUND EVAL 83-97 MIN,5500515,CDM,440,RC,,,outpatient,,,661.25,330.63,,641.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,396.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,595.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,595.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,396.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,481.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,451.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,396.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,533.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,533.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,585.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,438.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,535.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,608.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,628.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,641.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,429.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,396.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,396.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,396.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,595.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,396.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,396.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,595.13,
ST SOUND EVAL 98-112 MIN,5500516,CDM,440,RC,,,outpatient,,,770,385,,746.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,462,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,693,90,,,percent of total billed charges,Pays at 90% of total billed charges,693,90,,,percent of total billed charges,Pays at 90% of total billed charges,462,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,560.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,525.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,462,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,621.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,621.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,682.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,510.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,623.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,708.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,731.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,746.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,500.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,462,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,462,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,462,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,693,90,,,percent of total billed charges,Pays at 90% of total billed charges,462,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,462,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,693,
ST SOUND EVAL 113-127 MIN,5500517,CDM,440,RC,,,outpatient,,,878.5,439.25,,852.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,790.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,790.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,639.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,599.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,709.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,709.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,778.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,582.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,711.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,808.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,834.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,852.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,571.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,790.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,790.65,
Evaluation of speech sound production with evaluation of language comprehension,5500520,CDM,440,RC,,,outpatient,,,358.75,179.38,,347.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,322.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,322.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,261.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,244.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,289.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,289.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,317.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,237.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,290.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,330.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,340.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,347.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,233.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,322.88,
Evaluation of speech sound production with evaluation of language comprehension,5500521,CDM,440,RC,,,outpatient,,,412.75,206.38,,400.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,371.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,371.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,300.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,281.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,333.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,333.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,365.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,273.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,334.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,379.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,392.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,400.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,268.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,371.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,371.48,
Evaluation of speech sound production with evaluation of language comprehension,5500522,CDM,440,RC,,,outpatient,,,521.75,260.88,,506.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,469.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,469.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,379.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,356.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,421.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,462.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,345.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,422.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,480.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,495.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,506.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,339.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,469.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,469.58,
Evaluation of speech sound production with evaluation of language comprehension,5500523,CDM,440,RC,,,outpatient,,,684.5,342.25,,663.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,616.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,616.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,498.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,467.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,552.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,552.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,606.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,453.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,554.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,629.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,650.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,663.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,444.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,616.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,616.05,
Evaluation of speech sound production with evaluation of language comprehension,5500524,CDM,440,RC,,,outpatient,,,738.75,369.38,,716.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,664.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,664.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,537.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,504.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,596.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,596.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,654.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,489.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,598.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,679.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,701.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,716.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,480.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,664.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,664.88,
Evaluation of speech sound production with evaluation of language comprehension,5500525,CDM,440,RC,,,outpatient,,,847.25,423.63,,821.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,762.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,762.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,616.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,578.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,683.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,683.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,750.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,561.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,686.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,779.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,804.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,821.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,550.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,762.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,762.53,
Evaluation of speech sound production with evaluation of language comprehension,5500526,CDM,440,RC,,,outpatient,,,956,478,,927.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,573.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,860.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,860.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,573.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,695.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,652.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,573.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,771.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,771.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,847.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,633.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,774.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,879.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,908.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,927.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,621.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,573.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,573.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,573.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,860.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,573.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,573.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,860.4,
Evaluation of speech sound production with evaluation of language comprehension,5500527,CDM,440,RC,,,outpatient,,,1064.25,532.13,,1032.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,957.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,957.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,774.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,726.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,859.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,859.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,943.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,705.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,862.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,979.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,1011.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,1032.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,691.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,957.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,957.83,
ST VOICE/AUD PROCESS EVAL RESON 8-22 MIN,5500612,CDM,440,RC,,,outpatient,,,176.5,88.25,,171.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,158.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,158.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,117.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,142.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,162.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,171.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,158.85,
ST VOICE/AUD PROCESS EVAL RESON 23-37 MN,5500613,CDM,440,RC,,,outpatient,,,275.25,137.63,,266.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,165.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.27,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,165.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,222.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,253.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,165.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,165.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.73,
ST VOICE/AUD PROCESS EVAL RESON 38-52 MN,5500614,CDM,440,RC,,,outpatient,,,374,187,,362.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,336.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,336.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,272.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,255.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,301.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,301.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,331.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,247.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,302.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,344.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,355.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,362.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,243.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,336.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,336.6,
ST VOICE/AUD PROCESS EVAL RESON 53-67 MN,5500615,CDM,440,RC,,,outpatient,,,472.75,236.38,,458.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,425.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,425.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,343.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,322.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,381.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,418.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,313.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,382.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,434.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,449.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,458.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,307.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,425.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,425.48,
ST VOICE/AUD PROCESS EVAL RESON 68-82 MN,5500616,CDM,440,RC,,,outpatient,,,571.5,285.75,,554.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,342.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,514.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,514.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,342.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,415.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,390.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,342.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,461.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,461.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,506.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,378.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,462.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,525.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,542.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,554.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,371.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,342.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,514.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,342.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,342.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,514.35,
ST VOICE/AUD PROCESS EVAL RESON 83-97 MN,5500617,CDM,440,RC,,,outpatient,,,670.5,335.25,,650.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,603.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,603.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,487.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,457.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,541.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,541.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,594.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,444.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,543.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,616.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,636.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,650.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,435.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,603.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,603.45,
ST VOICE/AUD PROCESS EVAL RESON 98-112 M,5500618,CDM,440,RC,,,outpatient,,,769.5,384.75,,746.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,461.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,692.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,692.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,461.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,559.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,525.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,461.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,621.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,621.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,681.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,510.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,623.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,707.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,731.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,746.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,500.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,461.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,461.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,461.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,692.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,461.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,461.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,692.55,
ST VOICE/AUD PROCES EVAL RESON 113-127 M,5500619,CDM,440,RC,,,outpatient,,,868,434,,841.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,520.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,781.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,781.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,520.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,631.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,592.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,520.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,700.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,700.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,769.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,575.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,703.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,798.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,824.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,841.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,564.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,520.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,520.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,520.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,781.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,520.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,520.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,781.2,
Evaluation of speech sound production with evaluation of language comprehension,5500620,CDM,440,RC,,,outpatient,,,358.75,179.38,,347.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,322.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,322.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,261.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,244.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,289.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,289.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,317.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,237.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,290.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,330.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,340.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,347.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,233.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,322.88,
Evaluation of speech sound production with evaluation of language comprehension,5500621,CDM,440,RC,,,outpatient,,,412.75,206.38,,400.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,371.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,371.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,300.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,281.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,333.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,333.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,365.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,273.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,334.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,379.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,392.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,400.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,268.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,371.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,371.48,
Evaluation of speech sound production with evaluation of language comprehension,5500622,CDM,440,RC,,,outpatient,,,521.75,260.88,,506.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,469.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,469.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,379.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,356.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,421.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,462.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,345.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,422.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,480.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,495.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,506.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,339.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,469.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,469.58,
Evaluation of speech sound production with evaluation of language comprehension,5500623,CDM,440,RC,,,outpatient,,,684.5,342.25,,663.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,616.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,616.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,498.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,467.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,552.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,552.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,606.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,453.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,554.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,629.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,650.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,663.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,444.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,616.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,616.05,
Evaluation of speech sound production with evaluation of language comprehension,5500624,CDM,440,RC,,,outpatient,,,738.75,369.38,,716.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,664.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,664.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,537.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,504.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,596.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,596.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,654.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,489.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,598.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,679.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,701.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,716.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,480.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,664.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,664.88,
Evaluation of speech sound production with evaluation of language comprehension,5500625,CDM,440,RC,,,outpatient,,,847.25,423.63,,821.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,762.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,762.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,616.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,578.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,683.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,683.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,750.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,561.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,686.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,779.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,804.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,821.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,550.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,762.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,762.53,
Evaluation of speech sound production with evaluation of language comprehension,5500626,CDM,440,RC,,,outpatient,,,955.75,477.88,,927.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,573.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,860.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,860.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,573.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,695.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,652.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,573.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,771.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,771.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,846.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,633.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,774.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,879.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,907.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,927.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,621.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,573.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,573.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,573.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,860.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,573.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,573.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,860.18,
Evaluation of speech sound production with evaluation of language comprehension,5500627,CDM,440,RC,,,outpatient,,,1064.25,532.13,,1032.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,957.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,957.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,774.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,726.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,859.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,859.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,943.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,705.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,862.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,979.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,1011.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,1032.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,691.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,957.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,957.83,
ST SOUND EVAL 8-22 MIN KX,5500630,CDM,440,RC,,,outpatient,,,172.5,86.25,,167.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,155.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,117.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,139.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,158.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,163.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,167.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,103.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,155.25,
ST SOUND EVAL 23-37 MIN KX,5500631,CDM,440,RC,,,outpatient,,,227.25,113.63,,220.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,204.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,204.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,155.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,183.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,201.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,150.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,184.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,209.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,215.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,220.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,147.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,204.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,204.53,
ST SOUND EVAL 38-52 MIN KX,5500632,CDM,440,RC,,,outpatient,,,335.5,167.75,,325.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,301.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,301.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,244.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,228.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,270.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,270.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,297.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,222.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,271.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,308.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,318.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,325.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,218.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,301.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,201.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,301.95,
ST SOUND EVAL 53-67 MIN KX,5500633,CDM,440,RC,,,outpatient,,,498,249,,483.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,298.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,448.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,448.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,298.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,362.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,339.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,298.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,401.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,401.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,441.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,330.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,403.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,458.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,473.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,483.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,323.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,298.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,298.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,298.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,448.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,298.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,298.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,448.2,
ST SOUND EVAL 68-82 MIN KX,5500634,CDM,440,RC,,,outpatient,,,552.5,276.25,,535.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,497.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,497.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,402,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,377.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,445.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,445.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,489.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,366.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,447.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,508.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,524.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,535.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,359.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,497.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,497.25,
ST SOUND EVAL 83-97 MIN KX,5500635,CDM,440,RC,,,outpatient,,,661,330.5,,641.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,396.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,594.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,594.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,396.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,480.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,451.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,396.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,533.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,533.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,585.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,438.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,535.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,608.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,627.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,641.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,429.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,396.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,396.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,396.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,594.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,396.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,396.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,594.9,
ST SOUND EVAL 98-112 MIN KX,5500636,CDM,440,RC,,,outpatient,,,769.75,384.88,,746.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,461.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,692.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,692.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,461.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,560.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,525.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,461.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,621.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,621.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,682.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,510.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,623.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,708.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,731.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,746.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,500.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,461.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,461.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,461.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,692.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,461.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,461.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,692.78,
ST SOUND EVAL 113-127 MIN KX,5500637,CDM,440,RC,,,outpatient,,,878.5,439.25,,852.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,790.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,790.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,639.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,599.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,709.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,709.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,778.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,582.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,711.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,808.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,834.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,852.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,571.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,790.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,790.65,
ST FLUENCY EVAL 8-22 MIN KX,5500638,CDM,440,RC,,,outpatient,,,212,106,,205.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,190.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,190.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,144.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,171.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,187.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,140.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,171.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,195.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,201.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,205.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,137.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,190.8,
ST FLUENCY EVAL 23-37 MIN KX,5500639,CDM,440,RC,,,outpatient,,,266.25,133.13,,258.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,239.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,239.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,181.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,214.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,235.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,176.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,215.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,244.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,252.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,258.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,173.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,239.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,239.63,
ST FLUENCY EVAL 38-52 MIN KX,5500640,CDM,440,RC,,,outpatient,,,374.75,187.38,,363.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,337.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,337.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,272.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,255.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,302.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,302.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,332.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,248.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,303.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,344.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,356.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,363.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,243.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,337.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,337.28,
ST FLUENCY EVAL 53-67 MIN KX,5500641,CDM,440,RC,,,outpatient,,,538,269,,521.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,484.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,484.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,391.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,367.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,434.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,434.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,476.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,356.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,435.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,494.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,511.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,521.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,349.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,484.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,484.2,
ST FLUENCY EVAL 68-82 MIN KX,5500642,CDM,440,RC,,,outpatient,,,592,296,,574.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,355.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,532.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,532.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,355.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,430.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,404.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,355.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,477.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,477.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,524.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,392.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,479.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,544.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,562.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,574.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,384.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,355.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,355.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,355.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,532.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,355.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,355.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,532.8,
ST FLUENCY EVAL 83-97 MIN KX,5500643,CDM,440,RC,,,outpatient,,,700.75,350.38,,679.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,630.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,630.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,509.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,478.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,565.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,565.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,620.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,464.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,567.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,644.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,665.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,679.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,455.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,630.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,630.68,
ST FLUENCY EVAL 98-112 MIN KX,5500644,CDM,440,RC,,,outpatient,,,808.75,404.38,,784.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,485.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,727.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,727.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,485.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,588.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,551.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,485.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,652.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,652.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,716.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,536.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,655.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,744.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,768.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,784.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,525.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,485.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,727.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,485.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,485.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,727.88,
ST FLUENCY EVAL 113-127 MIN KX,5500645,CDM,440,RC,,,outpatient,,,917.5,458.75,,889.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,550.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,825.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,825.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,550.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,667.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,626.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,550.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,740.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,740.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,813,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,608.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,743.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,844.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,871.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,889.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,596.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,550.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,550.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,550.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,825.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,550.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,550.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,825.75,
Therapy for speech or hearing,5500646,CDM,441,RC,,,outpatient,,,71.5,35.75,,69.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,57.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,65.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,67.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,102.86,
Therapy for speech or hearing,5500647,CDM,441,RC,,,outpatient,,,139.75,69.88,,135.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,113.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,128.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,135.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,125.78,
Therapy for speech or hearing,5500648,CDM,441,RC,,,outpatient,,,208.25,104.13,,202,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,187.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,124.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,142.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,124.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,168.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,184.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,138.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,168.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,191.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,197.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,202,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,124.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,124.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,124.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,187.43,
Therapy for speech or hearing,5500649,CDM,441,RC,,,outpatient,,,277.75,138.88,,269.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,249.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,249.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,189.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,224.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,246.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,184.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,224.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,255.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,263.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,269.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,180.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,249.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,249.98,
Therapy for speech or hearing,5500650,CDM,441,RC,,,outpatient,,,345.25,172.63,,334.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,310.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,310.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,235.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,278.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,278.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,305.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,228.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,279.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,317.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,327.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,334.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,224.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,310.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,310.73,
Therapy for speech or hearing,5500651,CDM,441,RC,,,outpatient,,,412,206,,399.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,370.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,370.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,281.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,332.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,332.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,365.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,273.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,333.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,379.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,391.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,399.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,267.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,370.8,
Therapy for speech or hearing,5500652,CDM,441,RC,,,outpatient,,,479,239.5,,464.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,431.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,431.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,348.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,326.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,386.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,386.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,424.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,317.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,387.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,440.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,455.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,464.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,311.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,431.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,431.1,
Therapy for speech or hearing,5500653,CDM,441,RC,,,outpatient,,,547.75,273.88,,531.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,328.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,492.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,492.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,328.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,398.54,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,373.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,328.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,442.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,442.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,485.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,363.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,443.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,503.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,520.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,531.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,356.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,328.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,492.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,328.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,328.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,492.98,
ST VOICE/AUD PROC EVAL RESON 8-22 MIN KX,5500654,CDM,440,RC,,,outpatient,,,176.5,88.25,,171.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,158.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,158.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,117.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,142.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,162.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,171.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,158.85,
ST VOICE/AUD PROC EVAL RESON 23-37 MN KX,5500655,CDM,440,RC,,,outpatient,,,275.25,137.63,,266.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,165.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.27,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,165.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,222.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,253.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,165.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,165.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.73,
ST VOICE/AUD PROC EVAL RESON 38-52 MN KX,5500656,CDM,440,RC,,,outpatient,,,374,187,,362.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,336.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,336.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,272.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,255.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,301.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,301.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,331.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,247.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,302.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,344.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,355.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,362.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,243.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,336.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,336.6,
ST VOICE/AUD PROC EVAL RESON 53-67 MN KX,5500657,CDM,440,RC,,,outpatient,,,472.75,236.38,,458.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,425.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,425.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,343.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,322.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,381.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,418.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,313.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,382.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,434.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,449.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,458.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,307.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,425.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,425.48,
ST VOICE/AUD PROC EVAL RESON 68-82 MN KX,5500658,CDM,440,RC,,,outpatient,,,571.5,285.75,,554.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,342.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,514.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,514.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,342.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,415.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,390.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,342.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,461.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,461.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,506.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,378.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,462.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,525.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,542.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,554.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,371.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,342.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,514.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,342.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,342.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,514.35,
ST VOICE/AUD PROC EVAL RESON 83-97 MN KX,5500659,CDM,440,RC,,,outpatient,,,670.5,335.25,,650.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,603.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,603.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,487.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,457.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,541.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,541.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,594.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,444.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,543.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,616.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,636.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,650.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,435.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,603.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,603.45,
ST VOICE/AUD PROC EVAL RESON 98-112 M KX,5500660,CDM,440,RC,,,outpatient,,,769.5,384.75,,746.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,461.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,692.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,692.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,461.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,559.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,525.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,461.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,621.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,621.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,681.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,510.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,623.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,707.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,731.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,746.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,500.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,461.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,461.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,461.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,692.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,461.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,461.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,692.55,
ST VOICE/AUD PROC EVL RESON 113-127 M KX,5500661,CDM,440,RC,,,outpatient,,,868,434,,841.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,520.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,781.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,781.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,520.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,631.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,592.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,520.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,700.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,700.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,769.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,575.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,703.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,798.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,824.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,841.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,564.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,520.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,520.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,520.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,781.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,520.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,520.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,781.2,
ST APHASIA TEST PER HOUR KX,5500662,CDM,444,RC,,,outpatient,,,146.25,73.13,,141.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.83,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,99.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,129.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,96.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,118.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,134.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,138.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,141.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,131.63,
ST COGNITIVE TEST PER HOUR KX,5500663,CDM,444,RC,,,outpatient,,,175.75,87.88,,170.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,158.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,158.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,119.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,116.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,142.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,161.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,166.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,170.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,158.18,
ST PED SPEECH/COMP/COG TEST 1ST HR KX,5500664,CDM,918,RC,,,outpatient,,,261.75,130.88,,253.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,157.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,235.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,235.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,178.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,157.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,211.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,211.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,231.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,173.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,212.02,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,240.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,248.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,253.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,170.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,157.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,157.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,235.58,
ST PED SPEECH/CMP/COG TEST ADDT 30 MN KX,5500665,CDM,918,RC,,,outpatient,,,120,60,,116.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,108,90,,,percent of total billed charges,Pays at 90% of total billed charges,108,90,,,percent of total billed charges,Pays at 90% of total billed charges,72,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,81.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,114,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,78,65,,,percent of total billed charges,Pays at 65% of total billed charges,72,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108,90,,,percent of total billed charges,Pays at 90% of total billed charges,72,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,72,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108,
ST SW EVAL 8-22 MIN KX,5500666,CDM,444,RC,,,outpatient,,,71.5,35.75,,69.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,57.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,65.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,67.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,102.86,
ST SW EVAL 23-37 MIN KX,5500667,CDM,444,RC,,,outpatient,,,139.75,69.88,,135.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,113.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,128.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,135.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,125.78,
ST SW EVAL 38-52 MIN KX,5500668,CDM,444,RC,,,outpatient,,,208.25,104.13,,202,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,187.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,124.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,142.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,124.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,168.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,184.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,138.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,168.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,191.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,197.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,202,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,124.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,124.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,124.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,187.43,
ST SW EVAL 53-67 MIN KX,5500669,CDM,444,RC,,,outpatient,,,277.75,138.88,,269.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,249.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,249.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,189.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,224.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,246.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,184.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,224.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,255.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,263.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,269.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,180.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,249.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,249.98,
ST SW EVAL 68-82 MIN KX,5500670,CDM,444,RC,,,outpatient,,,345.25,172.63,,334.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,310.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,310.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,235.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,278.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,278.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,305.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,228.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,279.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,317.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,327.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,334.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,224.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,310.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,310.73,
ST SW EVAL 83-97 MIN KX,5500671,CDM,444,RC,,,outpatient,,,412,206,,399.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,370.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,370.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,281.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,332.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,332.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,365.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,273.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,333.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,379.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,391.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,399.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,267.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,370.8,
ST SW EVAL 98-112 MIN KX,5500672,CDM,444,RC,,,outpatient,,,479,239.5,,464.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,431.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,431.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,348.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,326.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,386.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,386.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,424.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,317.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,387.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,440.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,455.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,464.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,311.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,431.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,431.1,
ST SW EVAL 113-127 MIN KX,5500673,CDM,444,RC,,,outpatient,,,547.75,273.88,,531.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,328.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,492.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,492.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,328.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,398.54,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,373.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,328.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,442.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,442.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,485.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,363.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,443.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,503.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,520.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,531.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,356.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,328.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,492.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,328.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,328.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,492.98,
ST SW TX 8 TO 22 MIN KX,5500674,CDM,441,RC,,,outpatient,,,58,29,,56.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,52.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,46.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,53.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,55.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,56.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.8,102.86,
ST SW TX 23 TO 37 MIN KX,5500675,CDM,441,RC,,,outpatient,,,169.5,84.75,,164.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,152.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,115.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,112.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,137.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,155.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,161.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,164.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,110.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,152.55,
ST SW TX 38 TO 52 MIN KX,5500676,CDM,441,RC,,,outpatient,,,225.75,112.88,,218.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,203.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,154.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,182.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,207.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,214.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,218.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,203.18,
ST SW TX 53 TO 67 MIN KX,5500677,CDM,441,RC,,,outpatient,,,281.75,140.88,,273.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,169.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,253.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,253.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,169.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,192.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,169.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,227.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,249.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,186.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,228.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,259.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,267.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,273.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,183.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,169.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,253.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,169.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,169.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,253.58,
ST SW TX 68 TO 82 MIN KX,5500678,CDM,441,RC,,,outpatient,,,338.25,169.13,,328.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,304.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,304.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,246.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,230.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,273.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,299.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,224.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,273.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,311.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,321.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,328.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,219.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,304.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,304.43,
ST SW TX 83 TO 97 MIN KX,5500679,CDM,441,RC,,,outpatient,,,396.75,198.38,,384.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,357.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,357.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,288.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,270.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,320.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,351.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,263.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,321.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,365.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,376.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,384.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,257.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,357.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,357.08,
ST SW TX 98 TO 112 MIN KX,5500680,CDM,441,RC,,,outpatient,,,455,227.5,,441.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,409.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,409.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,331.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,310.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,367.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,367.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,403.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,301.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,368.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,418.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,432.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,441.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,295.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,409.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,409.5,
ST SW TX 113 TO 127 MIN KX,5500681,CDM,441,RC,,,outpatient,,,513,256.5,,497.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,307.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,461.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,461.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,307.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,373.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,350.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,307.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,414.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,414.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,454.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,340.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,415.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,471.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,487.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,497.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,333.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,307.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,307.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,307.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,461.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,307.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,307.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,461.7,
PT KX ORTH/PROS MNGT/TRAIN SUBSQ EA 15 M,5500763,CDM,421,RC,,,outpatient,,,125.75,62.88,,121.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.02,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,113.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,85.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,111.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,83.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,101.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,115.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,119.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,121.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,113.18,
PT  MEDI WIDE KNEE HIGH GARMENTS,5506530,CDM,271,RC,,,outpatient,,,66.5,33.25,,64.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,59.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,45.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,39.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,53.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,44.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,53.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,61.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,63.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,64.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,39.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,39.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.9,90,
PT KX EVAL LOW COMPLEX (20 MIN),5507161,CDM,424,RC,,,outpatient,,,220.75,110.38,,214.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,198.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,150.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,178.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,195.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,146.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,178.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,203.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,209.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,214.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,143.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,198.68,
PT KX EVAL MODERATE  COMPLEX (30 MIN),5507162,CDM,424,RC,,,outpatient,,,275.75,137.88,,267.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,165.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,248.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,248.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,188.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,165.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,222.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,244.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,223.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,253.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,267.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,179.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,165.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,248.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,165.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,248.18,
PT KX EVAL HIGH COMPLEX (45 MIN),5507163,CDM,424,RC,,,outpatient,,,331.25,165.63,,321.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,298.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,298.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,241.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,226.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,267.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,267.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,293.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,219.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,268.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,304.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,314.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,321.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,215.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,298.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,298.13,
PT KX REVAL LOW COMPLEX (20 MIN),5507164,CDM,424,RC,,,outpatient,,,148.25,74.13,,143.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,133.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,131.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,136.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,140.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,143.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,133.43,
OT KX EVAL LOW COMPLEX (30 MIN),5507165,CDM,434,RC,,,outpatient,,,237.5,118.75,,230.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,142.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,213.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,162.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,142.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,191.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,191.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,210.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,157.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,192.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,218.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,225.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,230.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,154.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,142.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,142.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,213.75,
OT KX EVAL MOD COMPLEX (45 MIN),5507166,CDM,434,RC,,,outpatient,,,296.25,148.13,,287.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,177.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,266.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,266.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,177.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,202.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,177.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,239.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,239.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,262.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,196.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,239.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,272.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,281.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,287.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,192.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,177.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,266.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,177.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,177.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,266.63,
OT KX EVAL HIGH COMPLEX (60 MIN),5507167,CDM,434,RC,,,outpatient,,,355.75,177.88,,345.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,320.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,258.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,242.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,213.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,315.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,235.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,288.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,327.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,337.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,345.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,231.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,213.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,213.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,320.18,
OT KX REEVAL (30 MIN),5507168,CDM,434,RC,,,outpatient,,,177.25,88.63,,171.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,159.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,157.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,117.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,143.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,163.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,168.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,171.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,115.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,159.53,
Repeated application to one or more parts of the body,5510004,CDM,420,RC,,,outpatient,,,63.75,31.88,,61.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,57.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,51.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,58.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,60.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,61.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.25,102.86,
One time use uttended,5510005,CDM,420,RC,,,outpatient,,,73.25,36.63,,71.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.35,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,49.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,59.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,48.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,59.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,67.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,69.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,71.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,102.86,
A type of physical therapy,5510008,CDM,420,RC,,,outpatient,,,95,47.5,,92.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,85.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,64.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,62.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,76.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,87.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,90.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,92.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57,102.86,
Manipulation of 1 or more regions of the body,5510012,CDM,420,RC,,,outpatient,,,101.5,50.75,,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,82.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,93.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
A technique used by physical therapists to restore normal body movement patterns,5510016,CDM,420,RC,,,outpatient,,,113,56.5,,109.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,101.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,103.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,107.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,109.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
PT KX PARAFFIN BATH,5510019,CDM,420,RC,,,outpatient,,,115.25,57.63,,111.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.73,
Form of decompression therapy of the spine,5510023,CDM,420,RC,,,outpatient,,,56.5,28.25,,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,45.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,51.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,53.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,102.86,
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",5510025,CDM,420,RC,,,outpatient,,,109,54.5,,105.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,74.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,72.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,88.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,100.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,103.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,105.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Use of sound waves to treat medical problems, especially musculoskeletal problems like inflammation from injuries",5510026,CDM,420,RC,,,outpatient,,,103.75,51.88,,100.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,93.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,93.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,70.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,68.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,84.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,95.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,98.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,100.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,62.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Occupatiol therapy,5510062,CDM,420,RC,,,outpatient,,,116.25,58.13,,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,104.63,
PT KX THERAPEUTIC EXER /GROUP EA 15,5510066,CDM,420,RC,,,outpatient,,,69.25,34.63,,67.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.83,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,62.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,41.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,45.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,56.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,63.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,65.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,67.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,41.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,41.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.55,102.86,
PT KX WC MGMT TRAIN 15 MIN,5510072,CDM,420,RC,,,outpatient,,,105.75,52.88,,102.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.23,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,95.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,72.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,85.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,97.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,100.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,102.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,63.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Psychiatric treatment in which seizures are electrically induced in patients to provide relief from mental disorders,5510096,CDM,420,RC,,,outpatient,,,92.25,46.13,,89.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,83.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,62.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,74.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,84.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,55.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.35,102.86,
Use of water for therapy/exercises,5510112,CDM,420,RC,,,outpatient,,,131.5,65.75,,127.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,118.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,106.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,120.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,124.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,127.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,118.35,
PT KX WORK CONDITION INITIAL 2 HRS,5510302,CDM,420,RC,,,outpatient,,,270.25,135.13,,262.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.25,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,243.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,243.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,184.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,218.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,239.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,179.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,218.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,248.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,256.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,262.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,175.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,243.23,
PT KX WORK CONDITIONING EA ADD HR,5510314,CDM,420,RC,,,outpatient,,,101.75,50.88,,98.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,91.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,61.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,82.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,93.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,61.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,61.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
One time use uttended,5519005,CDM,420,RC,,,outpatient,,,73.25,36.63,,71.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.35,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,49.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,59.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,48.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,59.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,67.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,69.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,71.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,102.86,
A type of physical therapy,5519008,CDM,420,RC,,,outpatient,,,95,47.5,,92.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,85.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,64.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,62.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,76.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,87.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,90.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,92.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57,102.86,
Manipulation of 1 or more regions of the body,5519012,CDM,420,RC,,,outpatient,,,101.5,50.75,,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,82.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,93.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
A technique used by physical therapists to restore normal body movement patterns,5519016,CDM,420,RC,,,outpatient,,,113,56.5,,109.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,101.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,103.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,107.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,109.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Form of decompression therapy of the spine,5519023,CDM,420,RC,,,outpatient,,,56.5,28.25,,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,45.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,51.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,53.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,102.86,
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",5519025,CDM,420,RC,,,outpatient,,,109,54.5,,105.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,74.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,72.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,88.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,100.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,103.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,105.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Use of sound waves to treat medical problems, especially musculoskeletal problems like inflammation from injuries",5519026,CDM,420,RC,,,outpatient,,,103.75,51.88,,100.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,93.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,93.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,70.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,68.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,84.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,95.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,98.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,100.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,62.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Occupatiol therapy,5519062,CDM,420,RC,,,outpatient,,,116.25,58.13,,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,104.63,
PT NEEDLE INSERTION 1-2 MUSCLES DRY NEED,5520560,CDM,420,RC,,,outpatient,,,102.75,51.38,,99.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,92.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,70.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,68.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,94.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,97.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,99.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
PT NEEDLE INSERTION 3 > MUSCLES DRY NEED,5520561,CDM,420,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.45,
PT APPLICATION COMPRESSION SYS BELOW KNE,5529581,CDM,420,RC,,,outpatient,,,189,94.5,,183.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.55,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,170.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,170.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,128.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,167.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,125.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,153.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,173.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,179.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,183.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,122.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,170.1,
PT APP COMP SYS UPPER ARM FOREARM HAND F,5529584,CDM,420,RC,,,outpatient,,,189,94.5,,183.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,170.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,170.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,128.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,167.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,125.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,153.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,173.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,179.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,183.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,122.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,170.1,
"Incorporates the use of multiple parameters, such as balance, strength, and range of motion, for a functiol activity",5530007,CDM,420,RC,,,outpatient,,,115,57.5,,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,105.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.5,
"Incorporates the use of multiple parameters, such as balance, strength, and range of motion, for a functiol activity",5539007,CDM,420,RC,,,outpatient,,,115,57.5,,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,105.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.5,
PT AQUATIC EVAL LOW COMPLEX (20 MIN),5577161,CDM,424,RC,,,outpatient,,,220.75,110.38,,214.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,198.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,150.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,178.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,195.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,146.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,178.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,203.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,209.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,214.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,143.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,198.68,
PT AQUATIC EVAL MODERAT COMPLEX (30 MIN),5577162,CDM,424,RC,,,outpatient,,,276,138,,267.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,248.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,248.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,188.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,222.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,244.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,223.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,253.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,262.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,267.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,179.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,248.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,248.4,
PT AQUATIC EVAL HIGH COMPLEX (45 MIN),5577163,CDM,424,RC,,,outpatient,,,331.25,165.63,,321.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,298.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,298.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,241.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,226.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,267.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,267.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,293.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,219.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,268.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,304.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,314.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,321.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,215.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,298.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,298.13,
PT AQUATIC RE-EVAL LOW COMPLEX (20 MIN),5577164,CDM,424,RC,,,outpatient,,,148.5,74.25,,144.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,133.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,131.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,136.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,133.65,
One time use uttended,5590005,CDM,420,RC,,,outpatient,,,73.25,36.63,,71.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.35,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,49.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,59.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,48.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,59.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,67.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,69.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,71.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,102.86,
"Incorporates the use of multiple parameters, such as balance, strength, and range of motion, for a functiol activity",5590007,CDM,420,RC,,,outpatient,,,115,57.5,,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,105.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.5,
A type of physical therapy,5590008,CDM,420,RC,,,outpatient,,,95,47.5,,92.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,85.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,64.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,62.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,76.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,87.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,90.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,92.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57,102.86,
Manipulation of 1 or more regions of the body,5590012,CDM,420,RC,,,outpatient,,,101.5,50.75,,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,82.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,93.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
A technique used by physical therapists to restore normal body movement patterns,5590016,CDM,420,RC,,,outpatient,,,113.25,56.63,,109.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,101.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,75.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,104.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,107.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,109.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Form of decompression therapy of the spine,5590023,CDM,420,RC,,,outpatient,,,56.5,28.25,,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,45.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,51.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,53.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,102.86,
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",5590025,CDM,420,RC,,,outpatient,,,109,54.5,,105.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,74.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,72.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,88.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,100.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,103.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,105.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Use of sound waves to treat medical problems, especially musculoskeletal problems like inflammation from injuries",5590026,CDM,420,RC,,,outpatient,,,104,52,,100.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,93.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,93.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,70.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,68.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,84.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,95.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,98.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,100.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Occupatiol therapy,5590062,CDM,420,RC,,,outpatient,,,116.25,58.13,,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,104.63,
PT BIOFEEDBACK PERINEAL MUS ANORECT URET,5590912,CDM,917,RC,,,outpatient,,,85.25,42.63,,82.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,76.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,80.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,82.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,51.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.15,102.86,
ST APHASIA TEST PER HOUR,5596105,CDM,444,RC,,,outpatient,,,146.25,73.13,,141.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.83,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,99.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,129.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,96.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,118.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,134.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,138.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,141.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,131.63,
ST PED SPEECH/COMP/COG TEST 1ST HR,5596112,CDM,918,RC,,,outpatient,,,262,131,,254.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,157.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,235.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,235.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,178.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,157.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,211.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,211.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,232.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,173.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,212.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,241.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,248.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,254.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,170.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,157.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,157.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,235.8,
ST PED SPEECH/COMP/COG TEST ADDTL 30 MIN,5596113,CDM,918,RC,,,outpatient,,,120.25,60.13,,116.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,108.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.23,
ST COGNITIVE TEST PER HOUR,5596125,CDM,444,RC,,,outpatient,,,175.75,87.88,,170.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,158.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,158.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,119.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,116.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,142.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,161.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,166.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,170.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,158.18,
PT EVAL LOW COMPLEX (20 MIN),5597161,CDM,424,RC,,,outpatient,,,220.75,110.38,,214.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,198.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,150.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,178.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,195.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,146.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,178.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,203.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,209.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,214.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,143.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,198.68,
PT EVAL MODERATE  COMPLEX (30 MIN),5597162,CDM,424,RC,,,outpatient,,,276,138,,267.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,248.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,248.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,188.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,222.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,244.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,223.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,253.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,262.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,267.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,179.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,248.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,248.4,
PT EVAL HIGH COMPLEX (45 MIN),5597163,CDM,424,RC,,,outpatient,,,331.25,165.63,,321.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,298.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,298.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,241.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,226.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,267.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,267.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,293.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,219.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,268.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,304.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,314.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,321.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,215.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,298.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,298.13,
PT REVAL LOW COMPLEX (20 MIN),5597164,CDM,424,RC,,,outpatient,,,148.5,74.25,,144.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,133.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,131.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,136.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,133.65,
OT EVAL LOW COMPLEX (20 MIN),5597165,CDM,434,RC,,,outpatient,,,237.75,118.88,,230.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,213.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,162.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,191.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,191.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,210.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,157.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,192.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,218.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,225.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,230.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,154.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,213.98,
OT EVAL MOD COMPLEX (30 MIN),5597166,CDM,434,RC,,,outpatient,,,296.5,148.25,,287.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,177.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,266.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,266.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,177.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,202.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,177.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,239.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,239.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,262.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,196.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,240.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,272.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,281.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,287.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,192.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,177.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,266.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,177.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,177.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,266.85,
OT EVAL HIGH COMPLEX (45 MIN),5597167,CDM,434,RC,,,outpatient,,,356,178,,345.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,242.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,315.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,236.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,288.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,327.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,338.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,345.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,231.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,213.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,320.4,
OT REEVAL (30 MIN),5597168,CDM,434,RC,,,outpatient,,,177.25,88.63,,171.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,159.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,157.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,117.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,143.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,163.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,168.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,171.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,115.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,159.53,
PT PHYSICAL PERFOM TEST/MEASURE EA 15 MI,5597750,CDM,420,RC,,,outpatient,,,49.75,24.88,,48.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.55,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,44.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,33.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,32.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,40.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,45.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,47.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,48.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.85,102.86,
PT REEVAL LOW COMPLEX (20 MIN) MOD 59,5599164,CDM,424,RC,,,outpatient,,,148.5,74.25,,144.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,133.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,131.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,136.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,133.65,
PT CHS PHY ABILITY TEST PA003B,5599998,CDM,420,RC,,,outpatient,,,68.25,34.13,,66.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,45.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,55.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,62.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,66.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,90,
PT PRE-EMPLOYMENT SCREEN,5599999,CDM,420,RC,,,outpatient,,,112.5,56.25,,109.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,101.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,103.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,109.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,101.25,
PT CONTRAST BATHS 15MIN,5800002,CDM,420,RC,,,outpatient,,,55.75,27.88,,54.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.8,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,50.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,45.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,51.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,52.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,33.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.45,102.86,
Repeated application to one or more parts of the body,5800004,CDM,420,RC,,,outpatient,,,63.75,31.88,,61.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,57.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,51.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,58.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,60.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,61.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.25,102.86,
One time use uttended,5800005,CDM,420,RC,,,outpatient,,,73.25,36.63,,71.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.35,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,49.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,59.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,48.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,59.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,67.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,69.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,71.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,102.86,
"Incorporates the use of multiple parameters, such as balance, strength, and range of motion, for a functiol activity",5800007,CDM,420,RC,,,outpatient,,,115,57.5,,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,105.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.5,
A type of physical therapy,5800008,CDM,420,RC,,,outpatient,,,95,47.5,,92.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,85.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,64.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,62.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,76.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,87.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,90.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,92.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57,102.86,
Manipulation of 1 or more regions of the body,5800012,CDM,420,RC,,,outpatient,,,101.5,50.75,,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,82.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,93.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Use of massage,5800015,CDM,420,RC,,,outpatient,,,90.25,45.13,,87.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,73.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,83.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,85.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,87.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,102.86,
A technique used by physical therapists to restore normal body movement patterns,5800016,CDM,420,RC,,,outpatient,,,113.25,56.63,,109.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,101.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,75.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,104.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,107.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,109.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
PT ORTH/PROS MNGT/TRAIN SUBSQ EA 15 MIN,5800017,CDM,421,RC,,,outpatient,,,125.75,62.88,,121.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.02,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,113.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,85.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,111.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,83.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,101.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,115.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,119.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,121.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,113.18,
PT PARAFFIN BATH,5800019,CDM,420,RC,,,outpatient,,,115.25,57.63,,111.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.73,
Form of decompression therapy of the spine,5800023,CDM,420,RC,,,outpatient,,,56.5,28.25,,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,45.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,51.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,53.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,102.86,
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",5800025,CDM,420,RC,,,outpatient,,,109,54.5,,105.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,74.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,72.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,88.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,100.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,103.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,105.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Use of sound waves to treat medical problems, especially musculoskeletal problems like inflammation from injuries",5800026,CDM,420,RC,,,outpatient,,,104,52,,100.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,93.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,93.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,70.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,68.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,84.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,95.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,98.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,100.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
.PAC BAND STANDARD,5800032,CDM,271,RC,,,outpatient,,,12,6,,11.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,
PT ORTHO FIT/TRAIN 15 MIN INIT ENC,5800056,CDM,420,RC,,,outpatient,,,124.75,62.38,,121.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,85.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,82.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,101.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,114.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,118.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,121.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,112.28,
PT KX ORTHO FIT/TRAIN 15 MIN INIT ENC,5800057,CDM,420,RC,,,outpatient,,,124.75,62.38,,121.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,85.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,82.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,101.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,114.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,118.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,121.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,112.28,
Occupatiol therapy,5800062,CDM,420,RC,,,outpatient,,,116.25,58.13,,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,104.63,
PT THERAPEUTIC EXER /GROUP EA 15,5800066,CDM,420,RC,,,outpatient,,,69.5,34.75,,67.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.83,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,56.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,63.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,67.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,102.86,
PT WC MGMT TRAIN 15 MIN,5800072,CDM,420,RC,,,outpatient,,,116.25,58.13,,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.23,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,104.63,
Psychiatric treatment in which seizures are electrically induced in patients to provide relief from mental disorders,5800096,CDM,420,RC,,,outpatient,,,92.5,46.25,,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,74.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,102.86,
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",5800186,CDM,430,RC,,,outpatient,,,108.75,54.38,,105.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,97.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,74.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,72.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,88.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,100.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,103.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,105.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",5800187,CDM,430,RC,,,outpatient,,,109,54.5,,105.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,74.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,72.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,88.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,100.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,103.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,105.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
A technique used by physical therapists to restore normal body movement patterns,5800188,CDM,430,RC,,,outpatient,,,113,56.5,,109.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,101.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,103.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,107.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,109.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
A technique used by physical therapists to restore normal body movement patterns,5800189,CDM,430,RC,,,outpatient,,,113,56.5,,109.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,101.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,103.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,107.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,109.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Manipulation of 1 or more regions of the body,5800194,CDM,430,RC,,,outpatient,,,101.5,50.75,,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,82.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,93.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Manipulation of 1 or more regions of the body,5800195,CDM,430,RC,,,outpatient,,,101.5,50.75,,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,82.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,93.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Incorporates the use of multiple parameters, such as balance, strength, and range of motion, for a functiol activity",5800198,CDM,430,RC,,,outpatient,,,114.25,57.13,,110.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,102.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,102.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,75.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,92.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,105.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,108.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,110.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Incorporates the use of multiple parameters, such as balance, strength, and range of motion, for a functiol activity",5800199,CDM,430,RC,,,outpatient,,,114.25,57.13,,110.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,102.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,102.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,75.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,92.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,105.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,108.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,110.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
OT SENSORY INTEGRATIVE TECH EA 15 MIN,5800202,CDM,430,RC,,,outpatient,,,100,50,,97,97,,,percent of total billed charges,Pays at 97% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.15,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,90,90,,,percent of total billed charges,Pays at 90% of total billed charges,90,90,,,percent of total billed charges,Pays at 90% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,68.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,66.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,92,92,,,percent of total billed charges,Pays at 92% of total billed charges,95,95,,,percent of total billed charges,Pays at 95% of total billed charges,97,97,,,percent of total billed charges,Pays at 97% of total billed charges,65,65,,,percent of total billed charges,Pays at 65% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90,90,,,percent of total billed charges,Pays at 90% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
OT KX SENSORY INTEGRATIVE TECH EA 15 MIN,5800203,CDM,430,RC,,,outpatient,,,100,50,,97,97,,,percent of total billed charges,Pays at 97% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.15,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,90,90,,,percent of total billed charges,Pays at 90% of total billed charges,90,90,,,percent of total billed charges,Pays at 90% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,68.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,66.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,92,92,,,percent of total billed charges,Pays at 92% of total billed charges,95,95,,,percent of total billed charges,Pays at 95% of total billed charges,97,97,,,percent of total billed charges,Pays at 97% of total billed charges,65,65,,,percent of total billed charges,Pays at 65% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90,90,,,percent of total billed charges,Pays at 90% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Occupatiol therapy,5800204,CDM,430,RC,,,outpatient,,,115.5,57.75,,112.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,103.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.95,
Occupatiol therapy,5800205,CDM,430,RC,,,outpatient,,,115.5,57.75,,112.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,103.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.95,
OT WHEELCHAIR MGMT EA 15 MIN,5800208,CDM,430,RC,,,outpatient,,,106,53,,102.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.23,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,95.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,72.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,85.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,97.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,100.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,102.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
OT KX WHEELCHAIR MGMT EA 15 MIN,5800209,CDM,430,RC,,,outpatient,,,106,53,,102.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.23,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,95.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,72.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,85.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,97.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,100.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,102.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
OT ORTHOTIC TRAIN & MGMT EA 15 MIN INIT,5800216,CDM,430,RC,,,outpatient,,,124.75,62.38,,121.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,85.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,82.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,101.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,114.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,118.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,121.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,112.28,
OT KX ORTHOTIC TRAIN & MGMT EA 15 INIT E,5800217,CDM,430,RC,,,outpatient,,,124.75,62.38,,121.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,85.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,82.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,101.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,114.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,118.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,121.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,112.28,
OT KX ORTH/PROS MNGT/TRAIN SUBSQ EA 15 M,5800221,CDM,430,RC,,,outpatient,,,125.75,62.88,,121.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.02,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,113.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,85.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,111.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,83.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,101.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,115.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,119.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,121.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,113.18,
PT FOOT ORTHOTICS,5800300,CDM,274,RC,,,outpatient,,,235.75,117.88,,228.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,212.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,212.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,160.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,190.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,156.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,190.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,216.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,223.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,228.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,153.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,212.18,
PT WORK CONDIITONING EA ADD HOUR,5800318,CDM,420,RC,,,outpatient,,,108,54,,104.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,97.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,95.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,71.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,87.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,99.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,102.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,104.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Therapy for speech or hearing,5800411,CDM,441,RC,,,outpatient,,,71.5,35.75,,69.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,57.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,65.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,67.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,102.86,
Therapy for speech or hearing,5800412,CDM,441,RC,,,outpatient,,,139.75,69.88,,135.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,113.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,128.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,135.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,125.78,
Therapy for speech or hearing,5800413,CDM,441,RC,,,outpatient,,,208.5,104.25,,202.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,187.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,142.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,168.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,184.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,138.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,168.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,191.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,198.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,202.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,187.65,
Therapy for speech or hearing,5800414,CDM,441,RC,,,outpatient,,,277.75,138.88,,269.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,249.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,249.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,189.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,224.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,246.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,184.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,224.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,255.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,263.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,269.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,180.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,249.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,249.98,
Therapy for speech or hearing,5800415,CDM,441,RC,,,outpatient,,,345.25,172.63,,334.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,310.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,310.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,235.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,278.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,278.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,305.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,228.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,279.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,317.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,327.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,334.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,224.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,310.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,310.73,
Therapy for speech or hearing,5800416,CDM,441,RC,,,outpatient,,,412,206,,399.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,370.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,370.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,281.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,332.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,332.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,365.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,273.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,333.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,379.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,391.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,399.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,267.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,370.8,
Therapy for speech or hearing,5800417,CDM,441,RC,,,outpatient,,,479,239.5,,464.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,431.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,431.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,348.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,326.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,386.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,386.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,424.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,317.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,387.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,440.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,455.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,464.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,311.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,431.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,431.1,
Therapy for speech or hearing,5800418,CDM,441,RC,,,outpatient,,,548,274,,531.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,493.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,493.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,398.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,374.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,442.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,442.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,485.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,363.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,443.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,504.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,520.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,531.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,356.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,493.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,493.2,
ST SW EVAL 8-22 MIN KX,5800421,CDM,444,RC,,,outpatient,,,71.5,35.75,,69.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,57.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,65.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,67.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,102.86,
ST SW EVAL 23-37 MIN,5800422,CDM,444,RC,,,outpatient,,,139.75,69.88,,135.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,113.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,128.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,135.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,125.78,
ST SW EVAL 38-52 MIN,5800423,CDM,444,RC,,,outpatient,,,208.5,104.25,,202.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,187.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,142.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,168.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,184.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,138.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,168.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,191.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,198.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,202.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,187.65,
ST SW EVAL 53-67 MIN,5800424,CDM,444,RC,,,outpatient,,,277.75,138.88,,269.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,249.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,249.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,189.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,224.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,246.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,184.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,224.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,255.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,263.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,269.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,180.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,249.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,249.98,
ST SW EVAL 68-82 MIN,5800425,CDM,444,RC,,,outpatient,,,345.25,172.63,,334.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,310.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,310.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,235.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,278.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,278.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,305.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,228.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,279.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,317.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,327.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,334.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,224.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,310.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,310.73,
ST SW EVAL 83-97 MIN,5800426,CDM,444,RC,,,outpatient,,,412,206,,399.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,370.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,370.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,281.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,332.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,332.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,365.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,273.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,333.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,379.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,391.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,399.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,267.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,370.8,
ST SW EVAL 98-112 MIN,5800427,CDM,444,RC,,,outpatient,,,479,239.5,,464.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,431.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,431.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,348.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,326.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,386.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,386.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,424.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,317.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,387.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,440.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,455.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,464.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,311.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,431.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,431.1,
ST SW EVAL 113-127 MIN,5800428,CDM,444,RC,,,outpatient,,,548,274,,531.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,493.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,493.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,398.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,374.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,442.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,442.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,485.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,363.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,443.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,504.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,520.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,531.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,356.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,493.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,493.2,
ST SW TX 8 TO 22 MIN,5800429,CDM,441,RC,,,outpatient,,,58,29,,56.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,52.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,46.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,53.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,55.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,56.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.8,102.86,
ST SW TX 23 TO 37 MIN,5800430,CDM,441,RC,,,outpatient,,,169.5,84.75,,164.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,152.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,115.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,112.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,137.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,155.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,161.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,164.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,110.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,152.55,
ST SW TX 38 TO 52 MIN,5800431,CDM,441,RC,,,outpatient,,,225.75,112.88,,218.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,203.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,154.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,182.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,207.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,214.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,218.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,203.18,
ST SW TX 53 TO 67 MIN,5800432,CDM,441,RC,,,outpatient,,,282,141,,273.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,253.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,253.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,192.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,227.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,249.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,186.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,228.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,259.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,267.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,273.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,183.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,253.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,253.8,
ST SW TX 68 TO 82 MIN,5800433,CDM,441,RC,,,outpatient,,,338.25,169.13,,328.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,304.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,304.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,246.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,230.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,273.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,299.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,224.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,273.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,311.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,321.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,328.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,219.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,304.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,304.43,
ST SW TX 83 TO 97 MIN,5800434,CDM,441,RC,,,outpatient,,,396.75,198.38,,384.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,357.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,357.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,288.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,270.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,320.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,351.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,263.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,321.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,365.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,376.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,384.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,257.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,357.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,357.08,
ST SW TX 98 TO 112 MIN,5800435,CDM,441,RC,,,outpatient,,,455,227.5,,441.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,409.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,409.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,331.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,310.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,367.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,367.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,403.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,301.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,368.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,418.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,432.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,441.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,295.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,409.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,409.5,
ST SW TX 113 TO 127 MIN,5800436,CDM,441,RC,,,outpatient,,,513.25,256.63,,497.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,461.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,461.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,373.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,350.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,414.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,414.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,454.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,340.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,415.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,472.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,487.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,497.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,333.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,461.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,461.93,
ST FLUENCY EVAL 8-22 MIN,5800500,CDM,440,RC,,,outpatient,,,212,106,,205.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,190.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,190.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,144.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,171.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,187.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,140.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,171.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,195.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,201.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,205.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,137.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,190.8,
ST FLUENCY EVAL 23-37 MIN,5800501,CDM,440,RC,,,outpatient,,,266.25,133.13,,258.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,239.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,239.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,181.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,214.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,235.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,176.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,215.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,244.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,252.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,258.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,173.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,239.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,239.63,
ST FLUENCY EVAL 38-52 MIN,5800502,CDM,440,RC,,,outpatient,,,374.75,187.38,,363.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,337.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,337.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,272.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,255.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,302.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,302.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,332.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,248.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,303.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,344.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,356.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,363.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,243.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,337.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,337.28,
ST FLUENCY EVAL 53-67 MIN,5800503,CDM,440,RC,,,outpatient,,,538,269,,521.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,484.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,484.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,391.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,367.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,434.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,434.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,476.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,356.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,435.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,494.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,511.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,521.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,349.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,484.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,484.2,
ST FLUENCY EVAL 68-82 MIN,5800504,CDM,440,RC,,,outpatient,,,592.25,296.13,,574.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,355.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,533.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,533.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,355.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,430.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,404.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,355.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,478.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,478.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,524.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,392.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,479.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,544.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,562.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,574.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,384.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,355.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,355.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,355.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,533.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,355.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,355.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,533.03,
ST FLUENCY EVAL 83-97 MIN,5800505,CDM,440,RC,,,outpatient,,,700.75,350.38,,679.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,630.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,630.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,509.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,478.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,565.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,565.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,620.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,464.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,567.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,644.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,665.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,679.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,455.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,630.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,630.68,
ST FLUENCY EVAL 98-112 MIN,5800506,CDM,440,RC,,,outpatient,,,809,404.5,,784.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,485.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,728.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,728.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,485.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,588.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,552.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,485.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,653.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,653.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,716.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,536.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,655.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,744.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,768.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,784.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,525.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,485.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,728.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,485.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,485.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,728.1,
ST FLUENCY EVAL 113-127 MIN,5800507,CDM,440,RC,,,outpatient,,,917.75,458.88,,890.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,550.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,825.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,825.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,550.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,667.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,626.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,550.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,740.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,740.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,813.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,608.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,743.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,844.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,871.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,890.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,596.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,550.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,550.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,550.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,825.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,550.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,550.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,825.98,
ST SOUND EVAL 8-22 MIN,5800510,CDM,440,RC,,,outpatient,,,172.75,86.38,,167.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,155.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,117.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,153.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,139.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,158.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,164.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,167.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,103.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,155.48,
ST SOUND EVAL 23-37 MIN,5800511,CDM,440,RC,,,outpatient,,,227.25,113.63,,220.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,204.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,204.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,155.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,183.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,201.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,150.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,184.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,209.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,215.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,220.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,147.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,204.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,204.53,
ST SOUND EVAL 38-52 MIN,5800512,CDM,440,RC,,,outpatient,,,335.75,167.88,,325.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,302.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,302.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,244.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,229.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,271.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,297.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,222.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,271.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,308.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,318.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,325.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,218.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,302.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,302.18,
ST SOUND EVAL 53-67 MIN,5800513,CDM,440,RC,,,outpatient,,,498.25,249.13,,483.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,298.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,448.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,448.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,298.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,362.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,340.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,298.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,402.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,402.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,441.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,330.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,403.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,458.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,473.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,483.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,323.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,298.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,298.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,298.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,448.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,298.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,298.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,448.43,
ST SOUND EVAL 68-82 MIN,5800514,CDM,440,RC,,,outpatient,,,552.5,276.25,,535.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,497.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,497.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,402,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,377.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,445.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,445.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,489.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,366.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,447.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,508.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,524.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,535.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,359.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,497.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,497.25,
ST SOUND EVAL 83-97 MIN,5800515,CDM,440,RC,,,outpatient,,,661.25,330.63,,641.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,396.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,595.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,595.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,396.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,481.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,451.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,396.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,533.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,533.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,585.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,438.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,535.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,608.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,628.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,641.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,429.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,396.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,396.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,396.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,595.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,396.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,396.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,595.13,
ST SOUND EVAL 98-112 MIN,5800516,CDM,440,RC,,,outpatient,,,770,385,,746.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,462,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,693,90,,,percent of total billed charges,Pays at 90% of total billed charges,693,90,,,percent of total billed charges,Pays at 90% of total billed charges,462,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,560.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,525.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,462,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,621.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,621.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,682.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,510.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,623.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,708.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,731.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,746.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,500.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,462,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,462,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,462,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,693,90,,,percent of total billed charges,Pays at 90% of total billed charges,462,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,462,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,693,
ST SOUND EVAL 113-127 MIN,5800517,CDM,440,RC,,,outpatient,,,878.5,439.25,,852.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,790.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,790.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,639.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,599.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,709.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,709.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,778.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,582.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,711.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,808.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,834.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,852.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,571.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,790.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,790.65,
Evaluation of speech sound production with evaluation of language comprehension,5800520,CDM,440,RC,,,outpatient,,,358.75,179.38,,347.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,322.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,322.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,261.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,244.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,289.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,289.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,317.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,237.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,290.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,330.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,340.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,347.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,233.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,322.88,
Evaluation of speech sound production with evaluation of language comprehension,5800521,CDM,440,RC,,,outpatient,,,412.75,206.38,,400.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,371.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,371.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,300.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,281.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,333.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,333.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,365.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,273.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,334.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,379.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,392.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,400.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,268.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,371.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,371.48,
Evaluation of speech sound production with evaluation of language comprehension,5800522,CDM,440,RC,,,outpatient,,,521.75,260.88,,506.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,469.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,469.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,379.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,356.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,421.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,462.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,345.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,422.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,480.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,495.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,506.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,339.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,469.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,469.58,
Evaluation of speech sound production with evaluation of language comprehension,5800523,CDM,440,RC,,,outpatient,,,684.5,342.25,,663.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,616.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,616.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,498.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,467.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,552.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,552.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,606.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,453.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,554.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,629.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,650.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,663.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,444.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,616.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,616.05,
Evaluation of speech sound production with evaluation of language comprehension,5800524,CDM,440,RC,,,outpatient,,,738.75,369.38,,716.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,664.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,664.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,537.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,504.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,596.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,596.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,654.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,489.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,598.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,679.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,701.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,716.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,480.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,664.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,664.88,
Evaluation of speech sound production with evaluation of language comprehension,5800525,CDM,440,RC,,,outpatient,,,847.25,423.63,,821.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,762.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,762.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,616.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,578.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,683.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,683.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,750.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,561.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,686.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,779.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,804.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,821.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,550.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,762.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,762.53,
Evaluation of speech sound production with evaluation of language comprehension,5800526,CDM,440,RC,,,outpatient,,,956,478,,927.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,573.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,860.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,860.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,573.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,695.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,652.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,573.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,771.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,771.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,847.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,633.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,774.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,879.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,908.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,927.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,621.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,573.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,573.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,573.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,860.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,573.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,573.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,860.4,
Evaluation of speech sound production with evaluation of language comprehension,5800527,CDM,440,RC,,,outpatient,,,1064.25,532.13,,1032.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,957.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,957.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,774.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,726.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,859.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,859.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,943.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,705.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,862.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,979.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,1011.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,1032.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,691.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,957.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,957.83,
ST VOICE/AUD PROCESS EVAL RESON 8-22 MIN,5800612,CDM,440,RC,,,outpatient,,,176.5,88.25,,171.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,158.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,158.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,117.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,142.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,162.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,171.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,158.85,
ST VOICE/AUD PROCESS EVAL RESON 23-37 MN,5800613,CDM,440,RC,,,outpatient,,,275.5,137.75,,267.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,165.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,188.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,165.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,222.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,244.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,223.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,253.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,267.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,179.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,165.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,165.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.95,
ST VOICE/AUD PROCESS EVAL RESON 38-52 MN,5800614,CDM,440,RC,,,outpatient,,,374,187,,362.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,336.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,336.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,272.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,255.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,301.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,301.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,331.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,247.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,302.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,344.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,355.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,362.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,243.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,336.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,336.6,
ST VOICE/AUD PROCESS EVAL RESON 53-67 MN,5800615,CDM,440,RC,,,outpatient,,,472.75,236.38,,458.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,425.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,425.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,343.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,322.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,381.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,418.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,313.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,382.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,434.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,449.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,458.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,307.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,425.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,425.48,
ST VOICE/AUD PROCESS EVAL RESON 68-82 MN,5800616,CDM,440,RC,,,outpatient,,,571.75,285.88,,554.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,343.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,514.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,514.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,343.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,416.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,390.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,343.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,461.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,461.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,506.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,379.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,463.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,526.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,543.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,554.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,371.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,343.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,343.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,343.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,514.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,343.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,343.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,514.58,
ST VOICE/AUD PROCESS EVAL RESON 83-97 MN,5800617,CDM,440,RC,,,outpatient,,,670.5,335.25,,650.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,603.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,603.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,487.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,457.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,541.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,541.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,594.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,444.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,543.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,616.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,636.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,650.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,435.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,603.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,603.45,
ST VOICE/AUD PROCESS EVAL RESON 98-112 M,5800618,CDM,440,RC,,,outpatient,,,769.75,384.88,,746.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,461.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,692.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,692.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,461.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,560.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,525.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,461.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,621.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,621.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,682.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,510.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,623.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,708.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,731.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,746.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,500.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,461.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,461.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,461.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,692.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,461.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,461.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,692.78,
ST VOICE/AUD PROCES EVAL RESON 113-127 M,5800619,CDM,440,RC,,,outpatient,,,868.25,434.13,,842.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,520.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,781.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,781.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,520.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,631.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,592.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,520.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,700.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,700.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,769.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,575.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,703.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,798.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,824.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,842.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,564.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,520.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,520.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,520.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,781.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,520.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,520.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,781.43,
Evaluation of speech sound production with evaluation of language comprehension,5800620,CDM,440,RC,,,outpatient,,,358.75,179.38,,347.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,322.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,322.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,261.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,244.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,289.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,289.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,317.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,237.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,290.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,330.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,340.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,347.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,233.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,215.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,322.88,
Evaluation of speech sound production with evaluation of language comprehension,5800621,CDM,440,RC,,,outpatient,,,412.75,206.38,,400.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,371.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,371.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,300.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,281.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,333.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,333.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,365.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,273.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,334.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,379.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,392.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,400.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,268.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,371.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,247.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,371.48,
Evaluation of speech sound production with evaluation of language comprehension,5800622,CDM,440,RC,,,outpatient,,,521.75,260.88,,506.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,469.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,469.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,379.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,356.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,421.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,462.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,345.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,422.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,480.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,495.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,506.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,339.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,469.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,313.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,469.58,
Evaluation of speech sound production with evaluation of language comprehension,5800623,CDM,440,RC,,,outpatient,,,684.5,342.25,,663.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,616.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,616.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,498.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,467.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,552.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,552.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,606.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,453.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,554.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,629.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,650.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,663.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,444.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,616.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,410.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,616.05,
Evaluation of speech sound production with evaluation of language comprehension,5800624,CDM,440,RC,,,outpatient,,,738.75,369.38,,716.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,664.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,664.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,537.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,504.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,596.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,596.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,654.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,489.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,598.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,679.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,701.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,716.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,480.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,664.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,443.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,664.88,
Evaluation of speech sound production with evaluation of language comprehension,5800625,CDM,440,RC,,,outpatient,,,847.25,423.63,,821.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,762.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,762.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,616.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,578.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,683.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,683.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,750.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,561.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,686.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,779.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,804.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,821.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,550.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,762.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,508.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,762.53,
Evaluation of speech sound production with evaluation of language comprehension,5800626,CDM,440,RC,,,outpatient,,,956,478,,927.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,573.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,860.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,860.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,573.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,695.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,652.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,573.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,771.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,771.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,847.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,633.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,774.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,879.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,908.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,927.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,621.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,573.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,573.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,573.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,860.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,573.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,573.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,860.4,
Evaluation of speech sound production with evaluation of language comprehension,5800627,CDM,440,RC,,,outpatient,,,1064.25,532.13,,1032.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,957.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,957.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,774.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,726.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,859.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,859.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,943.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,705.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,862.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,979.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,1011.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,1032.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,691.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,957.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,638.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,957.83,
ST SOUND EVAL 8-22 MIN KX,5800630,CDM,440,RC,,,outpatient,,,172.75,86.38,,167.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,155.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,117.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,103.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,153.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,114.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,139.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,158.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,164.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,167.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,103.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,103.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,155.48,
ST SOUND EVAL 23-37 MIN KX,5800631,CDM,440,RC,,,outpatient,,,227.25,113.63,,220.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,204.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,204.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,155.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,183.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,201.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,150.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,184.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,209.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,215.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,220.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,147.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,204.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,136.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,204.53,
ST SOUND EVAL 38-52 MIN KX,5800632,CDM,440,RC,,,outpatient,,,335.75,167.88,,325.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,302.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,302.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,244.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,229.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,271.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,297.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,222.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,271.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,308.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,318.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,325.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,218.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,302.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,302.18,
ST SOUND EVAL 53-67 MIN KX,5800633,CDM,440,RC,,,outpatient,,,498.25,249.13,,483.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,298.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,448.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,448.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,298.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,362.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,340.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,298.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,402.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,402.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,441.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,330.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,403.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,458.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,473.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,483.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,323.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,298.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,298.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,298.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,448.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,298.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,298.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,448.43,
ST SOUND EVAL 68-82 MIN KX,5800634,CDM,440,RC,,,outpatient,,,552.5,276.25,,535.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,497.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,497.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,402,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,377.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,445.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,445.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,489.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,366.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,447.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,508.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,524.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,535.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,359.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,497.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,331.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,497.25,
ST SOUND EVAL 83-97 MIN KX,5800635,CDM,440,RC,,,outpatient,,,661.25,330.63,,641.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,396.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,595.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,595.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,396.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,481.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,451.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,396.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,533.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,533.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,585.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,438.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,535.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,608.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,628.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,641.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,429.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,396.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,396.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,396.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,595.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,396.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,396.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,595.13,
ST SOUND EVAL 98-112 MIN KX,5800636,CDM,440,RC,,,outpatient,,,770,385,,746.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,462,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,693,90,,,percent of total billed charges,Pays at 90% of total billed charges,693,90,,,percent of total billed charges,Pays at 90% of total billed charges,462,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,560.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,525.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,462,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,621.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,621.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,682.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,510.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,623.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,708.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,731.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,746.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,500.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,462,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,462,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,462,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,693,90,,,percent of total billed charges,Pays at 90% of total billed charges,462,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,462,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,693,
ST SOUND EVAL 113-127 MIN KX,5800637,CDM,440,RC,,,outpatient,,,878.5,439.25,,852.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,790.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,790.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,639.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,599.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,709.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,709.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,778.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,582.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,711.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,808.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,834.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,852.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,571.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,790.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,527.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,790.65,
ST FLUENCY EVAL 8-22 MIN KX,5800638,CDM,440,RC,,,outpatient,,,212,106,,205.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,190.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,190.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,144.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,171.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,187.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,140.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,171.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,195.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,201.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,205.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,137.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,190.8,
ST FLUENCY EVAL 23-37 MIN KX,5800639,CDM,440,RC,,,outpatient,,,266.25,133.13,,258.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,239.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,239.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,181.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,214.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,235.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,176.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,215.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,244.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,252.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,258.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,173.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,239.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,239.63,
ST FLUENCY EVAL 38-52 MIN KX,5800640,CDM,440,RC,,,outpatient,,,374.75,187.38,,363.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,337.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,337.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,272.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,255.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,302.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,302.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,332.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,248.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,303.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,344.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,356.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,363.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,243.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,337.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,337.28,
ST FLUENCY EVAL 53-67 MIN KX,5800641,CDM,440,RC,,,outpatient,,,538,269,,521.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,484.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,484.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,391.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,367.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,434.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,434.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,476.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,356.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,435.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,494.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,511.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,521.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,349.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,484.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,484.2,
ST FLUENCY EVAL 68-82 MIN KX,5800642,CDM,440,RC,,,outpatient,,,592.25,296.13,,574.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,355.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,533.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,533.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,355.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,430.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,404.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,355.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,478.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,478.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,524.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,392.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,479.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,544.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,562.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,574.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,384.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,355.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,355.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,355.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,533.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,355.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,355.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,533.03,
ST FLUENCY EVAL 83-97 MIN KX,5800643,CDM,440,RC,,,outpatient,,,700.75,350.38,,679.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,630.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,630.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,509.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,478.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,565.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,565.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,620.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,464.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,567.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,644.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,665.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,679.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,455.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,630.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,420.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,630.68,
ST FLUENCY EVAL 98-112 MIN KX,5800644,CDM,440,RC,,,outpatient,,,809,404.5,,784.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,485.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,728.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,728.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,485.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,588.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,552.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,485.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,653.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,653.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,716.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,536.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,655.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,744.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,768.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,784.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,525.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,485.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,485.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,728.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,485.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,485.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,728.1,
ST FLUENCY EVAL 113-127 MIN KX,5800645,CDM,440,RC,,,outpatient,,,917.75,458.88,,890.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,550.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,825.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,825.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,550.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,667.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,626.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,550.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,740.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,740.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,813.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,608.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,743.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,844.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,871.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,890.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,596.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,550.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,550.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,550.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,825.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,550.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,550.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,825.98,
Therapy for speech or hearing,5800646,CDM,441,RC,,,outpatient,,,71.5,35.75,,69.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,57.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,65.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,67.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,102.86,
Therapy for speech or hearing,5800647,CDM,441,RC,,,outpatient,,,139.75,69.88,,135.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,113.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,128.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,135.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,125.78,
Therapy for speech or hearing,5800648,CDM,441,RC,,,outpatient,,,208.5,104.25,,202.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,187.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,142.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,168.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,184.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,138.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,168.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,191.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,198.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,202.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,187.65,
Therapy for speech or hearing,5800649,CDM,441,RC,,,outpatient,,,277.75,138.88,,269.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,249.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,249.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,189.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,224.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,246.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,184.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,224.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,255.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,263.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,269.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,180.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,249.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,249.98,
Therapy for speech or hearing,5800650,CDM,441,RC,,,outpatient,,,345.25,172.63,,334.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,310.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,310.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,235.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,278.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,278.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,305.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,228.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,279.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,317.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,327.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,334.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,224.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,310.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,310.73,
Therapy for speech or hearing,5800651,CDM,441,RC,,,outpatient,,,412,206,,399.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,370.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,370.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,281.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,332.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,332.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,365.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,273.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,333.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,379.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,391.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,399.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,267.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,370.8,
Therapy for speech or hearing,5800652,CDM,441,RC,,,outpatient,,,479,239.5,,464.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,431.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,431.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,348.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,326.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,386.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,386.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,424.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,317.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,387.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,440.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,455.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,464.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,311.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,431.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,431.1,
Therapy for speech or hearing,5800653,CDM,441,RC,,,outpatient,,,548,274,,531.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,493.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,493.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,398.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,374.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,442.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,442.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,485.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,363.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,443.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,504.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,520.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,531.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,356.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,493.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,493.2,
ST VOICE/AUD PROC EVAL RESON 8-22 MIN KX,5800654,CDM,440,RC,,,outpatient,,,176.5,88.25,,171.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,158.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,158.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,117.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,142.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,162.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,171.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,105.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,158.85,
ST VOICE/AUD PROC EVAL RESON 23-37 MN KX,5800655,CDM,440,RC,,,outpatient,,,275.5,137.75,,267.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,165.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,188.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,165.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,222.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,244.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,223.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,253.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,267.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,179.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,165.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,165.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.95,
ST VOICE/AUD PROC EVAL RESON 38-52 MN KX,5800656,CDM,440,RC,,,outpatient,,,374,187,,362.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,336.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,336.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,272.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,255.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,301.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,301.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,331.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,247.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,302.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,344.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,355.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,362.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,243.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,336.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,224.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,336.6,
ST VOICE/AUD PROC EVAL RESON 53-67 MN KX,5800657,CDM,440,RC,,,outpatient,,,472.75,236.38,,458.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,425.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,425.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,343.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,322.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,381.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,418.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,313.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,382.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,434.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,449.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,458.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,307.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,425.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,283.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,425.48,
ST VOICE/AUD PROC EVAL RESON 68-82 MN KX,5800658,CDM,440,RC,,,outpatient,,,571.75,285.88,,554.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,343.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,514.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,514.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,343.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,416.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,390.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,343.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,461.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,461.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,506.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,379.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,463.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,526.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,543.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,554.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,371.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,343.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,343.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,343.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,514.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,343.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,343.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,514.58,
ST VOICE/AUD PROC EVAL RESON 83-97 MN KX,5800659,CDM,440,RC,,,outpatient,,,670.5,335.25,,650.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,603.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,603.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,487.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,457.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,541.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,541.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,594.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,444.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,543.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,616.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,636.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,650.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,435.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,603.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,402.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,603.45,
ST VOICE/AUD PROC EVAL RESON 98-112 M KX,5800660,CDM,440,RC,,,outpatient,,,769.75,384.88,,746.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,461.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,692.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,692.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,461.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,560.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,525.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,461.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,621.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,621.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,682.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,510.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,623.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,708.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,731.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,746.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,500.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,461.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,461.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,461.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,692.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,461.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,461.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,692.78,
ST VOICE/AUD PROC EVL RESON 113-127 M KX,5800661,CDM,440,RC,,,outpatient,,,868.25,434.13,,842.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,520.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,781.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,781.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,520.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,631.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,592.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,520.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,700.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,700.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,769.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,575.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,703.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,798.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,824.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,842.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,564.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,520.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,520.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,520.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,781.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,520.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,520.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,781.43,
ST APHASIA TEST PER HOUR KX,5800662,CDM,444,RC,,,outpatient,,,146.25,73.13,,141.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.83,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,99.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,129.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,96.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,118.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,134.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,138.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,141.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,131.63,
ST COGNITIVE TEST PER HOUR KX,5800663,CDM,444,RC,,,outpatient,,,175.75,87.88,,170.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,158.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,158.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,119.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,116.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,142.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,161.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,166.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,170.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,158.18,
ST PED SPEECH/COMP/COG TEST 1ST HR KX,5800664,CDM,918,RC,,,outpatient,,,262,131,,254.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,157.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,235.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,235.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,178.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,157.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,211.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,211.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,232.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,173.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,212.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,241.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,248.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,254.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,170.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,157.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,157.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,235.8,
ST PED SPEECH/CMP/COG TEST ADDL 30 MN KX,5800665,CDM,918,RC,,,outpatient,,,120.25,60.13,,116.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,108.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.23,
ST SW EVAL 8-22 MIN KX,5800666,CDM,444,RC,,,outpatient,,,71.5,35.75,,69.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,57.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,65.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,67.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,42.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.9,102.86,
ST SW EVAL 23-37 MIN KX,5800667,CDM,444,RC,,,outpatient,,,139.75,69.88,,135.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,113.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,128.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,135.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,83.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,125.78,
ST SW EVAL 38-52 MIN KX,5800668,CDM,444,RC,,,outpatient,,,208.5,104.25,,202.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,187.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,142.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,168.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,184.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,138.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,168.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,191.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,198.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,202.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,125.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,187.65,
ST SW EVAL 53-67 MIN KX,5800669,CDM,444,RC,,,outpatient,,,277.75,138.88,,269.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,249.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,249.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,189.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,224.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,246.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,184.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,224.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,255.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,263.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,269.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,180.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,249.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,249.98,
ST SW EVAL 68-82 MIN KX,5800670,CDM,444,RC,,,outpatient,,,345.25,172.63,,334.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,310.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,310.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,235.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,278.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,278.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,305.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,228.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,279.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,317.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,327.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,334.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,224.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,310.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,207.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,310.73,
ST SW EVAL 83-97 MIN KX,5800671,CDM,444,RC,,,outpatient,,,412,206,,399.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,370.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,370.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,281.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,332.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,332.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,365.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,273.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,333.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,379.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,391.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,399.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,267.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,247.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,370.8,
ST SW EVAL 98-112 MIN KX,5800672,CDM,444,RC,,,outpatient,,,479,239.5,,464.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,431.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,431.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,348.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,326.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,386.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,386.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,424.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,317.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,387.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,440.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,455.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,464.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,311.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,431.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,287.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,431.1,
ST SW EVAL 113-127 MIN KX,5800673,CDM,444,RC,,,outpatient,,,548,274,,531.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,493.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,493.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,398.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,374.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,442.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,442.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,485.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,363.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,443.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,504.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,520.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,531.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,356.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,493.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,328.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,493.2,
ST SW TX 8 TO 22 MIN KX,5800674,CDM,441,RC,,,outpatient,,,58,29,,56.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,52.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,46.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,53.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,55.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,56.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,34.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.8,102.86,
ST SW TX 23 TO 37 MIN KX,5800675,CDM,441,RC,,,outpatient,,,169.5,84.75,,164.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,152.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,115.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,150.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,112.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,137.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,155.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,161.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,164.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,110.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,101.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,152.55,
ST SW TX 38 TO 52 MIN KX,5800676,CDM,441,RC,,,outpatient,,,225.75,112.88,,218.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,203.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,154.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,182.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,207.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,214.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,218.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,135.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,203.18,
ST SW TX 53 TO 67 MIN KX,5800677,CDM,441,RC,,,outpatient,,,282,141,,273.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,253.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,253.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,192.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,227.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,249.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,186.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,228.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,259.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,267.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,273.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,183.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,253.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,169.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,253.8,
ST SW TX 68 TO 82 MIN KX,5800678,CDM,441,RC,,,outpatient,,,338.25,169.13,,328.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,304.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,304.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,246.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,230.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,273.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,299.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,224.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,273.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,311.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,321.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,328.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,219.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,304.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,202.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,304.43,
ST SW TX 83 TO 97 MIN KX,5800679,CDM,441,RC,,,outpatient,,,396.75,198.38,,384.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,357.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,357.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,288.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,270.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,320.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,351.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,263.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,321.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,365.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,376.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,384.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,257.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,357.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,238.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,357.08,
ST SW TX 98 TO 112 MIN KX,5800680,CDM,441,RC,,,outpatient,,,455,227.5,,441.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,409.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,409.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,331.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,310.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,367.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,367.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,403.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,301.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,368.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,418.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,432.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,441.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,295.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,409.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,273,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,409.5,
ST SW TX 113 TO 127 MIN KX,5800681,CDM,441,RC,,,outpatient,,,513.25,256.63,,497.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,461.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,461.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,373.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,350.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,414.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,414.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,454.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,340.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,415.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,472.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,487.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,497.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,333.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,461.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,307.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,461.93,
PT KX ORT/PROS MNGT/TRAIN SBSQ EA 15 MIN,5800763,CDM,421,RC,,,outpatient,,,125.75,62.88,,121.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.02,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,113.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,85.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,111.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,83.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,101.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,115.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,119.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,121.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,75.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,113.18,
PT KX EVAL LOW COMPLEX (20 MIN),5807161,CDM,424,RC,,,outpatient,,,220.75,110.38,,214.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,198.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,150.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,178.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,195.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,146.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,178.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,203.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,209.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,214.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,143.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,198.68,
PT KX EVAL MODERATE  COMPLEX (30 MIN),5807162,CDM,424,RC,,,outpatient,,,276,138,,267.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,248.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,248.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,188.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,222.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,244.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,223.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,253.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,262.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,267.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,179.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,248.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,248.4,
PT KX EVAL HIGH COMPLEX (45 MIN),5807163,CDM,424,RC,,,outpatient,,,331.25,165.63,,321.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,298.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,298.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,241.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,226.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,267.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,267.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,293.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,219.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,268.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,304.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,314.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,321.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,215.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,298.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,298.13,
PT KX REVAL LOW COMPLEX (20 MIN),5807164,CDM,424,RC,,,outpatient,,,148.5,74.25,,144.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,133.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,131.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,136.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,133.65,
OT KX EVAL LOW COMPLEX (30 MIN),5807165,CDM,434,RC,,,outpatient,,,237.75,118.88,,230.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,213.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,162.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,191.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,191.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,210.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,157.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,192.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,218.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,225.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,230.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,154.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,213.98,
OT KX REEVAL (30 MIN),5807168,CDM,434,RC,,,outpatient,,,177.25,88.63,,171.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,159.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,157.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,117.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,143.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,163.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,168.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,171.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,115.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,159.53,
Repeated application to one or more parts of the body,5810004,CDM,420,RC,,,outpatient,,,63.75,31.88,,61.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,57.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,51.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,58.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,60.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,61.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,38.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.25,102.86,
One time use uttended,5810005,CDM,420,RC,,,outpatient,,,73.25,36.63,,71.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.35,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,49.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,59.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,48.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,59.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,67.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,69.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,71.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,102.86,
"Incorporates the use of multiple parameters, such as balance, strength, and range of motion, for a functiol activity",5810007,CDM,420,RC,,,outpatient,,,115,57.5,,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,105.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.5,
A type of physical therapy,5810008,CDM,420,RC,,,outpatient,,,95,47.5,,92.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,85.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,64.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,62.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,76.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,87.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,90.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,92.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57,102.86,
Manipulation of 1 or more regions of the body,5810012,CDM,420,RC,,,outpatient,,,101.5,50.75,,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,82.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,93.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Use of massage,5810015,CDM,420,RC,,,outpatient,,,90.25,45.13,,87.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,73.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,83.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,85.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,87.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,102.86,
A technique used by physical therapists to restore normal body movement patterns,5810016,CDM,420,RC,,,outpatient,,,113.25,56.63,,109.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,101.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,75.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,104.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,107.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,109.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
PT KX PARAFFIN BATH,5810019,CDM,420,RC,,,outpatient,,,115.25,57.63,,111.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.73,
Form of decompression therapy of the spine,5810023,CDM,420,RC,,,outpatient,,,56.5,28.25,,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,45.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,51.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,53.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,102.86,
Occupatiol therapy,5810062,CDM,420,RC,,,outpatient,,,116.25,58.13,,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,104.63,
PT KX THERAPEUTIC EXER /GROUP EA 15,5810066,CDM,420,RC,,,outpatient,,,69.5,34.75,,67.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.83,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,56.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,63.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,67.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,41.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.7,102.86,
PT KX WC MGMT TRAIN 15 MIN,5810072,CDM,420,RC,,,outpatient,,,106,53,,102.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.23,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,95.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,72.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,85.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,97.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,100.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,102.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,63.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Psychiatric treatment in which seizures are electrically induced in patients to provide relief from mental disorders,5810096,CDM,420,RC,,,outpatient,,,92.5,46.25,,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,74.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,102.86,
Use of water for therapy/exercises,5810112,CDM,420,RC,,,outpatient,,,131.5,65.75,,127.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,118.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,106.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,120.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,124.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,127.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,78.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,118.35,
PT KX WORK CONDIITON INITIAL 2 HRS,5810306,CDM,420,RC,,,outpatient,,,270.25,135.13,,262.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.25,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,243.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,243.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,184.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,218.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,239.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,179.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,218.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,248.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,256.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,262.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,175.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,243.23,
PT KX WORK CONDIITONING EA ADD HR,5810318,CDM,420,RC,,,outpatient,,,108,54,,104.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,97.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,95.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,71.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,87.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,99.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,102.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,104.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
One time use uttended,5819005,CDM,420,RC,,,outpatient,,,73.25,36.63,,71.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.35,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,49.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,59.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,48.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,59.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,67.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,69.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,71.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,102.86,
"Incorporates the use of multiple parameters, such as balance, strength, and range of motion, for a functiol activity",5819007,CDM,420,RC,,,outpatient,,,115,57.5,,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,105.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.5,
A type of physical therapy,5819008,CDM,420,RC,,,outpatient,,,95,47.5,,92.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,85.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,64.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,62.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,76.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,87.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,90.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,92.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57,102.86,
Manipulation of 1 or more regions of the body,5819012,CDM,420,RC,,,outpatient,,,101.5,50.75,,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,82.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,93.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
A technique used by physical therapists to restore normal body movement patterns,5819016,CDM,420,RC,,,outpatient,,,113.25,56.63,,109.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,101.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,75.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,104.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,107.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,109.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Form of decompression therapy of the spine,5819023,CDM,420,RC,,,outpatient,,,56.5,28.25,,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,45.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,51.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,53.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,102.86,
Occupatiol therapy,5819062,CDM,420,RC,,,outpatient,,,116.25,58.13,,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,104.63,
PT NEEDLE INSERTION 1-2 MUSCLES DRY NEED,5820560,CDM,420,RC,,,outpatient,,,102.75,51.38,,99.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,92.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,70.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,68.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,94.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,97.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,99.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,61.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
PT NEEDLE INSERTION 3 > MUSCLES DRY NEED,5820561,CDM,420,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.45,
PT APPLICATION COMPRESSION SYS BELOW KNE,5829581,CDM,420,RC,,,outpatient,,,189,94.5,,183.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.55,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,170.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,170.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,128.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,167.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,125.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,153.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,173.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,179.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,183.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,122.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,170.1,
PT APP COMP SYS UPPER ARM FOREARM HAND F,5829584,CDM,420,RC,,,outpatient,,,188.5,94.25,,182.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,169.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,169.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,128.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,167.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,124.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,152.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,173.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,179.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,182.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,122.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,113.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,169.65,
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",5830025,CDM,420,RC,,,outpatient,,,109,54.5,,105.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,74.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,72.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,88.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,100.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,103.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,105.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
PT WORK CONDIITONING INITIAL 2 HOURS,5830306,CDM,420,RC,,,outpatient,,,270.25,135.13,,262.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.25,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,243.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,243.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,184.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,218.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,239.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,179.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,218.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,248.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,256.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,262.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,175.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,162.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,243.23,
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",5839025,CDM,420,RC,,,outpatient,,,109,54.5,,105.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,74.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,72.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,88.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,100.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,103.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,105.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Use of sound waves to treat medical problems, especially musculoskeletal problems like inflammation from injuries",5840026,CDM,420,RC,,,outpatient,,,104,52,,100.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,93.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,93.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,70.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,68.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,84.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,95.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,98.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,100.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Use of sound waves to treat medical problems, especially musculoskeletal problems like inflammation from injuries",5849026,CDM,420,RC,,,outpatient,,,104,52,,100.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,93.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,93.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,70.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,68.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,84.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,95.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,98.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,100.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
One time use uttended,5890005,CDM,420,RC,,,outpatient,,,73.25,36.63,,71.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.35,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,49.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,59.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,48.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,59.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,67.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,69.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,71.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,102.86,
"Incorporates the use of multiple parameters, such as balance, strength, and range of motion, for a functiol activity",5890007,CDM,420,RC,,,outpatient,,,115,57.5,,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,78.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,105.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,111.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,103.5,
A type of physical therapy,5890008,CDM,420,RC,,,outpatient,,,95,47.5,,92.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,85.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,64.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,62.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,76.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,87.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,90.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,92.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57,102.86,
Manipulation of 1 or more regions of the body,5890012,CDM,420,RC,,,outpatient,,,101.5,50.75,,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,82.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,93.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
A technique used by physical therapists to restore normal body movement patterns,5890016,CDM,420,RC,,,outpatient,,,113.25,56.63,,109.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,101.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,75.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,104.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,107.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,109.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Form of decompression therapy of the spine,5890023,CDM,420,RC,,,outpatient,,,56.5,28.25,,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,45.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,51.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,53.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,102.86,
"Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes",5890025,CDM,420,RC,,,outpatient,,,109,54.5,,105.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,74.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,72.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,88.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,100.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,103.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,105.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,65.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Use of sound waves to treat medical problems, especially musculoskeletal problems like inflammation from injuries",5890026,CDM,420,RC,,,outpatient,,,104,52,,100.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,93.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,93.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,70.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,68.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,84.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,95.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,98.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,100.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,62.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Occupatiol therapy,5890062,CDM,420,RC,,,outpatient,,,116.25,58.13,,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,104.63,
ST APHASIA TEST PER HOUR,5896105,CDM,444,RC,,,outpatient,,,146.25,73.13,,141.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.83,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,99.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,129.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,96.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,118.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,134.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,138.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,141.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,131.63,
ST PED SPEECH/COMP/COG TEST 1ST HR,5896112,CDM,918,RC,,,outpatient,,,262,131,,254.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,157.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,235.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,235.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,178.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,157.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,211.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,211.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,232.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,173.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,212.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,241.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,248.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,254.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,170.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,157.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,157.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,235.8,
ST PED SPEECH/COMP/COG TEST ADDTL 30 MIN,5896113,CDM,918,RC,,,outpatient,,,120.25,60.13,,116.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,108.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,72.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.23,
ST COGNITIVE TEST PER HOUR,5896125,CDM,444,RC,,,outpatient,,,175.75,87.88,,170.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,158.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,158.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,119.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,116.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,142.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,161.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,166.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,170.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,105.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,158.18,
PT EVAL LOW COMPLEX (20 MIN),5897161,CDM,424,RC,,,outpatient,,,220.75,110.38,,214.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,198.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,150.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,178.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,195.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,146.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,178.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,203.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,209.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,214.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,143.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,198.68,
PT EVAL MODERATE  COMPLEX (30 MIN),5897162,CDM,424,RC,,,outpatient,,,276,138,,267.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,248.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,248.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,188.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,222.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,244.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,223.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,253.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,262.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,267.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,179.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,248.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,165.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,248.4,
PT EVAL HIGH COMPLEX (45 MIN),5897163,CDM,424,RC,,,outpatient,,,331.25,165.63,,321.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,298.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,298.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,241.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,226.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,267.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,267.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,293.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,219.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,268.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,304.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,314.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,321.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,215.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,298.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,298.13,
PT REVAL LOW COMPLEX (20 MIN),5897164,CDM,424,RC,,,outpatient,,,148.5,74.25,,144.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,133.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,131.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,136.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,133.65,
OT EVAL LOW COMPLEX (20 MIN),5897165,CDM,434,RC,,,outpatient,,,237.75,118.88,,230.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,213.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,162.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,191.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,191.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,210.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,157.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,192.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,218.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,225.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,230.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,154.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,142.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,213.98,
OT REEVAL (30 MIN),5897168,CDM,434,RC,,,outpatient,,,177.25,88.63,,171.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,159.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,157.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,117.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,143.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,163.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,168.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,171.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,115.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,106.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,159.53,
PT PHYSICAL PERFOM TEST/MEASURE EA 15 MI,5897750,CDM,420,RC,,,outpatient,,,49.75,24.88,,48.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.55,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,44.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,33.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,32.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,40.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,45.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,47.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,48.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,29.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.85,102.86,
PT REEVAL LOW COMPLEX (20 MIN) MOD 59,5899164,CDM,424,RC,,,outpatient,,,148.5,74.25,,144.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,133.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,131.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,136.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,133.65,
HT WT BP,6000001,CDM,450,RC,,,outpatient,,,18.25,9.13,,17.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,10.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.95,90,
OBSERVED COLLECTION,6000004,CDM,950,RC,,,outpatient,,,23.25,11.63,,22.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,20.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.95,90,
HAIR TESTING 7 PANEL,6000005,CDM,450,RC,,,outpatient,,,70,35,,67.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,42,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21,30,,,percent of total billed charges,Pays at 30% of total billed charges,63,90,,,percent of total billed charges,Pays at 90% of total billed charges,63,90,,,percent of total billed charges,Pays at 90% of total billed charges,42,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,56.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,64.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,67.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,42,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63,90,,,percent of total billed charges,Pays at 90% of total billed charges,42,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42,90,
Testing for presence of drug,6000006,CDM,300,RC,,,outpatient,,,60.75,30.38,,58.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,54.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,44.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,41.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,49.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,53.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,40.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.89,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,55.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,57.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,58.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,54.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,62.14,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,54.68,102.86,
T SPOT TB TESTING,6000007,CDM,300,RC,,,outpatient,,,110,55,,106.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33,30,,,percent of total billed charges,Pays at 30% of total billed charges,99,90,,,percent of total billed charges,Pays at 90% of total billed charges,99,90,,,percent of total billed charges,Pays at 90% of total billed charges,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,75.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,72.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,89.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,101.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,104.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,106.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99,90,,,percent of total billed charges,Pays at 90% of total billed charges,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,99,
OCH DRUG SCRN W/PKG(IN),6000009,CDM,300,RC,,,outpatient,,,75,37.5,,72.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,30,,,percent of total billed charges,Pays at 30% of total billed charges,67.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,49.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,60.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,69,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,72.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45,90,
BOE EXAM AT MD,6000019,CDM,450,RC,,,outpatient,,,146,73,,141.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,131.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,99.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,87.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,117.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,129.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,96.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,118.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,134.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,138.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,141.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,87.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,87.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,131.4,
ISHIHARA 24 PLATE,6000025,CDM,450,RC,,,outpatient,,,8.25,4.13,,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,90,
VISION TEST,6000026,CDM,450,RC,,,outpatient,,,8.25,4.13,,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,90,
Collection of venous blood by venipuncture,6000027,CDM,300,RC,,,outpatient,,,15.75,7.88,,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,11.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,14.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.57,102.86,
CSX FRA CERTIFICATION,6000028,CDM,450,RC,,,outpatient,,,52.75,26.38,,51.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.65,90,
HAIR SPEC COLL,6000030,CDM,450,RC,,,outpatient,,,15.5,7.75,,15.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.3,90,
Flu shot-high dose for 2019-2020 flu season given by injection for people >65,6000032,CDM,636,RC,,,outpatient,,,31.75,15.88,,30.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,28.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,29.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,30.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,19.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.05,102.86,
"Diphtheria, tetanus acellular, and pertussis vaccine for adults",6000038,CDM,636,RC,,,outpatient,,,75,37.5,,72.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,67.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,49.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,60.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,69,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,72.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45,102.86,
DIPHTHERIA/TETANUS(TENIVAC) INJ : 0.5ML,6000235,CDM,636,RC,,,outpatient,,,98.75,49.38,,95.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,88.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,59.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,79.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,90.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,93.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,95.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,59.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,59.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.25,102.86,
BOE EXAM AT PMH,6000519,CDM,450,RC,,,outpatient,,,128,64,,124.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,115.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,87.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,84.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,103.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,117.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,121.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,124.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,76.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,115.2,
WELLNESS 2000,6000800,CDM,510,RC,,,outpatient,,,24,12,,23.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.4,90,
Type of hearing test,6001002,CDM,450,RC,,,outpatient,,,27.75,13.88,,26.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.09,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,102.86,
TYPHOID VACCINE OHS,6001026,CDM,250,RC,,,outpatient,,,128.5,64.25,,124.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,87.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,85.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,104.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,118.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,122.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,124.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,115.65,
HEPATITIS B IMMUN SERIES,6001028,CDM,250,RC,,,outpatient,,,181,90.5,,175.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.3,30,,,percent of total billed charges,Pays at 30% of total billed charges,162.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,162.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,123.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,146.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,166.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,171.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,175.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,108.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,108.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,162.9,
HEP A IMMUNE SERIES,6001038,CDM,250,RC,,,outpatient,,,67.75,33.88,,65.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,44.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,54.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,62.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,65.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.65,90,
UDS /COLLECTION ONLY,6001074,CDM,300,RC,,,outpatient,,,14.25,7.13,,13.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,13.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,90,
SALIVA COLLECTION,6001075,CDM,950,RC,,,outpatient,,,16,8,,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.6,90,
MASK FIT,6001095,CDM,950,RC,,,outpatient,,,20.75,10.38,,20.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,19.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,20.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,12.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.45,90,
BREATH ALCOHOL SCREEN,6001116,CDM,950,RC,,,outpatient,,,29,14.5,,28.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.7,30,,,percent of total billed charges,Pays at 30% of total billed charges,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.4,90,
BREATH ALCOHOL W/CONFIRM,6001118,CDM,950,RC,,,outpatient,,,51.5,25.75,,49.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,46.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,35.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,41.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,47.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,48.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,49.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.9,90,
ANNUAL DRIVER FEE,6001155,CDM,950,RC,,,outpatient,,,60,30,,58.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,36,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,30,,,percent of total billed charges,Pays at 30% of total billed charges,54,90,,,percent of total billed charges,Pays at 90% of total billed charges,54,90,,,percent of total billed charges,Pays at 90% of total billed charges,36,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,40.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,36,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,53.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,39.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,48.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,55.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,57,95,,,percent of total billed charges,Pays at 95% of total billed charges,58.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,39,65,,,percent of total billed charges,Pays at 65% of total billed charges,36,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54,90,,,percent of total billed charges,Pays at 90% of total billed charges,36,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,36,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36,90,
Flu shot-high dose for 2019-2020 flu season given by injection for people >65,6001175,CDM,636,RC,,,outpatient,,,12.5,6.25,,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,102.86,
Flu shot-high dose for 2019-2020 flu season given by injection for people >65,6001177,CDM,636,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,102.86,
Immunization administration by a medical assistant or nurse,6001179,CDM,771,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,102.86,
ESCREEN CUP/COLL,6001200,CDM,950,RC,,,outpatient,,,22.75,11.38,,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,90,
ESCREEN COLL ONLY,6001202,CDM,950,RC,,,outpatient,,,10.5,5.25,,10.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,9.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,6.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,9.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,9.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,6.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.3,90,
Immunization administration by a medical assistant or nurse,6001277,CDM,771,RC,,,outpatient,,,12.5,6.25,,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,102.86,
"Measles, mumps and rubella vaccine",6001292,CDM,636,RC,,,outpatient,,,96.25,48.13,,93.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,86.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,65.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,63.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,77.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,88.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,91.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,93.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,57.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,57.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.75,102.86,
Hepatitis B vaccine,6001293,CDM,636,RC,,,outpatient,,,83.75,41.88,,81.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,75.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,57.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,55.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,67.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,77.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,79.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,81.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,50.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.25,102.86,
TB TEST 1 STEP,6001295,CDM,636,RC,,,outpatient,,,24.25,12.13,,23.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,90,
"Diphtheria, tetanus acellular, and pertussis vaccine for adults",6001502,CDM,636,RC,,,outpatient,,,73,36.5,,70.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,65.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,49.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,48.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,59.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,67.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,69.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,70.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.8,102.86,
IMM ADMIN EA ADDTL,6001510,CDM,771,RC,,,outpatient,,,18.75,9.38,,18.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,16.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,15.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,17.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,18.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,11.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,102.86,
PHYSICAL OHS,6001528,CDM,950,RC,,,outpatient,,,79.75,39.88,,77.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,71.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,75.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,47.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.85,90,
Outpatient visit of established patient not requiring a physician,6001567,CDM,950,RC,,,outpatient,,,110.25,55.13,,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,66.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,75.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,66.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,73.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,89.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,101.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,104.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,66.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,66.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,66.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
CONFIRMATION POS DOT,6002200,CDM,950,RC,,,outpatient,,,184,92,,178.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,110.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,165.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,125.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,110.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,163.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,149.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,169.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,174.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,178.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,119.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,110.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,110.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,165.6,
NUTRITNL THPY INIT 15MIN,8000005,CDM,942,RC,,,outpatient,,,65.25,32.63,,63.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.04,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,39.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,52.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,60.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,39.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,39.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.15,102.86,
NUTRITNL THPY RE 15 MIN,8000007,CDM,942,RC,,,outpatient,,,58.5,29.25,,56.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,52.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,47.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,53.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,55.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,56.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.1,102.86,
NUTRITNL THPY GRP 30 MIN,8000009,CDM,942,RC,,,outpatient,,,30,15,,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,27.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,102.86,
NUTRITINL COUNS REASSESS,8000011,CDM,942,RC,,,outpatient,,,58.5,29.25,,56.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,52.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,47.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,53.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,55.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,56.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,35.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.1,102.86,
NUTRITINL COUNSELING/GRP,8000013,CDM,942,RC,,,outpatient,,,30,15,,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,20.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,27.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,28.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,29.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27,90,,,percent of total billed charges,Pays at 90% of total billed charges,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,18,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18,102.86,
Test of hormone in the blood,10001205,CDM,300,RC,,,outpatient,,,182.75,91.38,,177.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,132.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,124.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,147.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,161.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.08,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,168.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,173.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,177.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,18.58,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.58,164.48,
BONE-SPECIFIC ALKP,10001894,CDM,300,RC,,,outpatient,,,62.25,31.13,,60.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,56.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,45.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,42.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,50.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.95,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,57.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,59.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,60.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,56.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,14.78,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.78,102.86,
AC PFIZER COVID 19 VAC ADMIN 1ST DOSE,11000019,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
OBS 1 MODERATE 2-23 HOURS,11000020,CDM,762,RC,,,outpatient,,,46.75,23.38,,45.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,37.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,43.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,28.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.05,90,
OBS 2 INTERMEDIATE 2-23 HOURS,11000022,CDM,762,RC,,,outpatient,,,53.75,26.88,,52.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,32.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,47.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,43.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,49.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,51.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,52.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,32.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,32.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.25,90,
AC PFIZER COVID 19 VAC ADMIN 3RD DOSE,11000025,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
AC PFIZER COVID 19 VAC ADMIN 2ND DOSE,11000029,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
OBS 1 INITIAL,11000030,CDM,762,RC,,,outpatient,,,278.5,139.25,,270.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,190.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,224.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,246.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,184.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,225.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,256.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,264.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,270.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,181.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,250.65,
OBS 2 INITIAL,11000032,CDM,762,RC,,,outpatient,,,348.25,174.13,,337.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,208.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,208.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,253.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,237.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,208.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,281.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,281.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,308.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,230.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,282.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,320.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,330.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,337.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,226.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,208.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,208.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,208.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,313.43,
SUBSEQUENT HOURS (25+),11000040,CDM,762,RC,,,outpatient,,,57.25,28.63,,55.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,34.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,46.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,52.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,54.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,55.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,34.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,34.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.35,90,
TELEMETRY SUBSEQUENT 25+,11000042,CDM,762,RC,,,outpatient,,,69.25,34.63,,67.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,41.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,45.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,56.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,63.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,65.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,67.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,41.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,41.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.55,90,
AC PFIZER COVID 19 VAC ADMIN BOOSTER,11000049,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
AC MODER COVID 19 VAC ADMIN 1ST DOSE,11000119,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
AC MODER COVID 19 VAC ADMIN 2ND DOSE,11000129,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
AC MODER COVID 19 VAC ADMIN 3RD DOSE,11000139,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
IV INFUSION CASIRIVI/IMDEVIMAB INF/POST,11000244,CDM,260,RC,,,outpatient,,,1500,750,,1455,97,,,percent of total billed charges,Pays at 97% of total billed charges,900,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,450,30,,,percent of total billed charges,Pays at 30% of total billed charges,1350,90,,,percent of total billed charges,Pays at 90% of total billed charges,1350,90,,,percent of total billed charges,Pays at 90% of total billed charges,900,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1091.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1023.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,900,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1210.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1210.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1329.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,994.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1215,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1380,92,,,percent of total billed charges,Pays at 92% of total billed charges,1425,95,,,percent of total billed charges,Pays at 95% of total billed charges,1455,97,,,percent of total billed charges,Pays at 97% of total billed charges,975,65,,,percent of total billed charges,Pays at 65% of total billed charges,900,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,900,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,900,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1350,90,,,percent of total billed charges,Pays at 90% of total billed charges,900,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,900,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1350,
IV INFUSION BAMLAN/ESTESEV INF/POST MON,11000245,CDM,760,RC,,,outpatient,,,643.25,321.63,,623.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,385.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,578.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,578.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,578.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,385.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,468.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,439.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,385.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,519.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,519.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,569.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,426.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,521.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,591.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,611.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,623.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,418.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,385.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,385.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,385.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,578.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,385.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,385.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,578.93,
AC JANSSEN COVID 19 VAC ADMIN,11000319,CDM,771,RC,,,outpatient,,,88.25,44.13,,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,81.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,90,
AC JANSSEN COVID 19 VAC ADMIN BOOSTER,11000349,CDM,771,RC,,,outpatient,,,88.25,44.13,,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,81.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,90,
AC PEDS PFIZER COVID19 VAC ADMIN 1ST DOS,11000719,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
AC PEDS PFIZER COVID19 VAC ADMIN 2ND DOS,11000729,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
Immunization administration by a medical assistant or nurse,11001002,CDM,771,RC,,,outpatient,,,28.25,14.13,,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,102.86,
Immunization administration by a medical assistant or nurse,11001004,CDM,771,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,102.86,
OBSERVATION DIRECT ADMIT,11001005,CDM,762,RC,,,outpatient,,,74.5,37.25,,72.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,50.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,44.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,49.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,60.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,68.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,70.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,72.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,44.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,44.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.7,90,
Immunization administration by a medical assistant or nurse,11001006,CDM,771,RC,,,outpatient,,,28.25,14.13,,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,102.86,
VACCINE ADMIN >1 EA,11001012,CDM,771,RC,,,outpatient,,,22.75,11.38,,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,102.86,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-same drug add on",11001026,CDM,260,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,102.86,
IV INF/HYD INIT 31 - 60 MIN MOD 59,11001028,CDM,260,RC,,,outpatient,,,226.25,113.13,,219.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,154.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,150,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,183.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,208.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,214.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,219.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,147.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,203.63,
IV HYD EA ADD HR-8 HR MOD 59,11001030,CDM,260,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",11001032,CDM,260,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",11001034,CDM,260,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
ADDTL SEQUENT INF UP-1HR MOD 59,11001036,CDM,260,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
IV INF/HYD INIT UP-1 HR MOD 59,11001038,CDM,260,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
THER INJ SQ OR IM MOD 59,11001040,CDM,260,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
THER INJ INTRA-ARTERIAL MOD 59,11001042,CDM,260,RC,,,outpatient,,,50.75,25.38,,49.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,41.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,46.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,48.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,49.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",11001044,CDM,260,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",11001046,CDM,260,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
PORT FLUSH ONLY,11001050,CDM,761,RC,,,outpatient,,,92.5,46.25,,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,74.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,102.86,
CATH FOR SEPECIMEN COLL,11001054,CDM,300,RC,,,outpatient,,,34.5,17.25,,33.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,31.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,32.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,,,,,Other,Not Separately reimbursable,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.57,100,
INSERT TEMP BLATTER CATH,11001086,CDM,761,RC,,,outpatient,,,127.25,63.63,,123.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.57,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,114.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,86.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,84.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,103.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,117.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,120.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,123.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,114.53,
CATH FOR SEPECIMEN COLL,11001088,CDM,300,RC,,,outpatient,,,34.5,17.25,,33.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,31.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,32.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,,,,,Other,Not Separately reimbursable,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.57,100,
DRUG ADMIN IV UP TO 1 HOUR,11001090,CDM,335,RC,,,outpatient,,,587,293.5,,569.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,352.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,528.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,528.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,352.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,427.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,400.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,352.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,473.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,473.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,520.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,389.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,475.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,540.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,557.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,569.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,381.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,352.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,352.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,352.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,528.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,352.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,352.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,528.3,
Chemotherapy infusion-each additiol hour,11001092,CDM,335,RC,,,outpatient,,,182.75,91.38,,177.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,124.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,161.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,148.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,168.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,173.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,177.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,164.48,
CATH /NONDWELLING,11001094,CDM,761,RC,,,outpatient,,,125,62.5,,121.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,112.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,85.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,82.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,101.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,115,92,,,percent of total billed charges,Pays at 92% of total billed charges,118.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,121.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,112.5,
IV INF/HYD INIT 31 - 60 MIN MOD XE,11001800,CDM,260,RC,,,outpatient,,,226.25,113.13,,219.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,154.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,150,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,183.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,208.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,214.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,219.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,147.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,203.63,
IV HYD EA ADD HR-8 HR MOD XE,11001801,CDM,260,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",11001802,CDM,260,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",11001803,CDM,260,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
ADDTL SEQUENT INF UP-1HR MOD XE,11001804,CDM,260,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
IV INF/HYD INIT UP-1 HR MOD XE,11001805,CDM,260,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
THER INJ SQ OR IM MOD XE,11001806,CDM,260,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",11001807,CDM,260,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",11001808,CDM,260,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-same drug add on",11001809,CDM,260,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,102.86,
IV INF/HYD INIT 31 - 60 MIN MOD XS,11001810,CDM,260,RC,,,outpatient,,,226.25,113.13,,219.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,154.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,150,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,183.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,208.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,214.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,219.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,147.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,203.63,
IV INF/HYD INIT 31 - 60 MIN MOD XS,11001811,CDM,260,RC,,,outpatient,,,226.25,113.13,,219.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,154.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,150,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,183.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,208.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,214.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,219.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,147.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,203.63,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",11001812,CDM,260,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",11001813,CDM,260,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
ADDTL SEQUENT INF UP-1HR MOD XS,11001814,CDM,260,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
IV INF/HYD INIT UP-1 HR MOD XS,11001815,CDM,260,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
THER INJ SQ OR IM MOD XS,11001816,CDM,260,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",11001817,CDM,260,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",11001818,CDM,260,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-same drug add on",11001819,CDM,260,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,102.86,
IV INF/HYD INIT 31 - 60 MIN MOD XU,11001820,CDM,260,RC,,,outpatient,,,226.25,113.13,,219.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,154.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,150,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,183.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,208.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,214.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,219.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,147.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,203.63,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",11001822,CDM,260,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",11001823,CDM,260,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
ADDTL SEQUENT INF UP-1HR MOD XU,11001824,CDM,260,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
IV INF/HYD INIT UP-1 HR MOD XU,11001825,CDM,260,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
THER INJ SQ OR IM MOD XU,11001826,CDM,260,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",11001827,CDM,260,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",11001828,CDM,260,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-same drug add on",11001829,CDM,260,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,102.86,
IV INF/HYD INIT 31 - 60 MIN MOD XP,11001830,CDM,260,RC,,,outpatient,,,226.25,113.13,,219.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,154.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,150,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,183.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,208.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,214.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,219.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,147.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,203.63,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",11001832,CDM,260,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",11001833,CDM,260,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
ADDTL SEQUENT INF UP-1HR MOD XP,11001834,CDM,260,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
IV INF/HYD INIT UP-1 HR MOD XP,11001835,CDM,260,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
THER INJ SQ OR IM MOD XP,11001836,CDM,260,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",11001837,CDM,260,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",11001838,CDM,260,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-same drug add on",11001839,CDM,260,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,102.86,
INTRO OF NEELE VEIN,11036000,CDM,761,RC,,,outpatient,,,64.75,32.38,,62.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,52.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,59.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,62.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.85,102.86,
INSERTION TUNN CENT INS CENTRAL ACCESS,11036558,CDM,761,RC,,,outpatient,,,472.5,236.25,,458.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,283.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,689.14,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,425.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,425.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,283.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,343.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,322.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,283.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,381.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,381.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,418.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,313.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,382.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,434.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,448.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,458.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,307.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,283.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,283.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,283.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,425.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,283.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,283.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,425.25,
PARACENTESIS,11049080,CDM,760,RC,,,outpatient,,,852.25,426.13,,826.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,511.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,839.94,90,,,percent of total billed charges,Pays at 90% of total billed charges,767.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,767.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,511.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,620.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,581.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,511.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,687.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,687.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,755.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,565.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,690.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,784.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,809.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,826.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,553.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,511.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,511.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,511.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,767.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,511.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,511.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,767.03,
IRRIGATE BLADDER,11051700,CDM,762,RC,,,outpatient,,,321.25,160.63,,311.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,357.26,90,,,percent of total billed charges,Pays at 90% of total billed charges,289.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,289.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,233.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,219.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,259.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,284.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,212.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,260.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,295.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,305.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,311.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,208.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,289.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,289.13,
REMOVAL IMPACTED CERUMEN IRRIGATION LAVA,11069209,CDM,761,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,102.86,
Immunization administration by a medical assistant or nurse,11090471,CDM,771,RC,,,outpatient,,,28.25,14.13,,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,102.86,
VACCINE ADMIN >1 EA,11090472,CDM,771,RC,,,outpatient,,,22.75,11.38,,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,102.86,
IV INF/HYD INIT 31 - 60 MIN,11096360,CDM,260,RC,,,outpatient,,,226.25,113.13,,219.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,154.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,150,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,183.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,208.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,214.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,219.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,147.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,203.63,
IV HYD EA ADD HR-8 HR,11096361,CDM,260,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",11096365,CDM,260,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",11096366,CDM,260,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
ADDTL SEQUENT INF UP-1HR,11096367,CDM,260,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
IV INF/HYD INIT UP-1 HR,11096368,CDM,260,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
THER INJ SQ OR IM,11096372,CDM,260,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
THER INJ INTRA-ARTERIAL,11096373,CDM,260,RC,,,outpatient,,,50.75,25.38,,49.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,41.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,46.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,48.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,49.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",11096374,CDM,260,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",11096375,CDM,260,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-same drug add on",11096376,CDM,260,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,102.86,
PORT FLUSH ONLY,11096523,CDM,260,RC,,,outpatient,,,92.5,46.25,,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,74.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,102.86,
NEGATIVE PRESSURE WOUND TX (VAC) W DME,11097605,CDM,940,RC,,,outpatient,,,81.75,40.88,,79.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,73.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,55.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,54.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,66.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,75.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,77.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,79.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,49.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.05,102.86,
POST ANES CARE /INITIAL,13500002,CDM,710,RC,,,outpatient,,,149.25,74.63,,144.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,134.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,89.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.33,
POST ANES CARE/EA 15 MIN,13500004,CDM,710,RC,,,outpatient,,,57.75,28.88,,56.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,51.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,34.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,38.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,46.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,53.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,54.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,56.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,34.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,34.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.65,90,
CENTRAL LINE <5 YRS,13500014,CDM,361,RC,,,outpatient,,,174.75,87.38,,169.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,157.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,119.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,115.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,141.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,160.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,166.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,169.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,104.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,157.28,
CPR,13500020,CDM,480,RC,,,outpatient,,,715.75,357.88,,694.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,429.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,295.77,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,644.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,644.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,429.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,520.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,488.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,429.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,577.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,577.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,634.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,474.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,579.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,658.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,679.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,694.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,465.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,429.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,429.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,429.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,644.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,429.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,429.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,644.18,
LUMBAR PUNCTURE,13500024,CDM,361,RC,,,outpatient,,,1506,753,,1460.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,903.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1355.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,1355.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,903.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1095.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1027.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,903.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1215.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1215.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1334.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,998.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1219.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1385.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,1430.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,1460.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,978.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,903.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,903.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,903.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1355.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,903.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,903.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1355.4,
INSERT PICC CATH > 5 YRS,13500028,CDM,761,RC,,,outpatient,,,1280.75,640.38,,1242.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1152.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1152.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,931.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,874.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1033.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1033.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1134.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,849.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1037.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1178.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,1216.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,1242.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,832.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1152.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1152.68,
COLL BLOOD CENTRAL/PERIPHERAL CATH,13500107,CDM,761,RC,,,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,102.86,100,,,Case rate,pays at 100% of fixed rate,,,,,Other,Not Separately reimbursable,100,102.86,
THORACENTESIS  NDLE OR CATH ASP W/O IM R,13502554,CDM,761,RC,,,outpatient,,,1623.25,811.63,,1574.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1460.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1460.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1181.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1107.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1310.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1310.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1438.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1076.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1314.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1493.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,1542.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,1574.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,1055.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1460.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1460.93,
TELEHEALTH STROKE ORIGITE SITE FAC FEE,13503014,CDM,780,RC,,,outpatient,,,69,34.5,,66.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,62.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,45.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,55.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,63.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,65.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,66.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.4,90,
THORACENTESIS  NDLE OR CATH ASP W/O IM L,13532554,CDM,761,RC,,,outpatient,,,1623.25,811.63,,1574.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1460.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1460.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1181.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1107.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1310.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1310.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1438.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1076.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1314.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1493.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,1542.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,1574.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,1055.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1460.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1460.93,
INSERT CV CATH OUTSIDE SERVICE PICC,13536569,CDM,761,RC,,,outpatient,,,1723,861.5,,1671.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1550.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1550.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1253.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1175.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1390.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1390.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1526.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1142.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1395.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1585.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,1636.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,1671.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,1119.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1550.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1550.7,
Outpatient visit of established patient not requiring a physician,13599211,CDM,510,RC,,,outpatient,,,42.5,21.25,,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,39.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,25.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.5,102.86,
OPERATING ROOM,14000001,CDM,360,RC,,,outpatient,,,2490.5,1245.25,,2415.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,1494.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,747.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,2241.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,2241.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,1494.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1812.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1699.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1494.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2010.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2010.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2206.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1651.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2017.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2291.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,2365.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,2415.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,1618.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,1494.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1494.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1494.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2241.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,1494.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1494.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2241.45,
SIGMOIDOSCOPY,14000003,CDM,360,RC,,,outpatient,,,1252.5,626.25,,1214.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,751.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,375.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,1127.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1127.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,751.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,911.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,854.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,751.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1011.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1011.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1109.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,830.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1014.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1152.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,1189.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,1214.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,814.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,751.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,751.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,751.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1127.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,751.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,751.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1127.25,
GASTROSCOPY,14000006,CDM,360,RC,,,outpatient,,,1252.5,626.25,,1214.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,751.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,375.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,1127.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1127.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,751.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,911.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,854.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,751.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1011.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1011.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1109.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,830.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1014.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1152.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,1189.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,1214.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,814.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,751.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,751.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,751.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1127.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,751.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,751.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1127.25,
CYSTOSCOPE,14000008,CDM,360,RC,,,outpatient,,,1252.5,626.25,,1214.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,751.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,375.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,1127.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1127.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,751.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,911.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,854.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,751.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1011.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1011.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1109.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,830.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1014.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1152.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,1189.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,1214.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,814.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,751.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,751.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,751.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1127.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,751.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,751.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1127.25,
COLONOSCOPY,14000009,CDM,360,RC,,,outpatient,,,1723.5,861.75,,1671.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,1034.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,517.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,1551.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,1551.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,1034.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1254.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1176.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1034.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1391.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1391.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1527.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1142.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1396.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1585.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,1637.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,1671.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,1120.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,1034.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1034.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1034.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1551.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,1034.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1034.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1551.15,
ESOPHAGAL DILATATION,14000010,CDM,360,RC,,,outpatient,,,1723.5,861.75,,1671.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,1034.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,517.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,1551.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,1551.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,1034.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1254.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1176.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1034.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1391.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1391.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1527.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1142.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1396.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1585.62,92,,,percent of total billed charges,Pays at 92% of total billed charges,1637.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,1671.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,1120.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,1034.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1034.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1034.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1551.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,1034.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1034.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1551.15,
OR,14000011,CDM,360,RC,,,outpatient,,,42.75,21.38,,41.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,39.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,90,
OR MINOR,14000015,CDM,360,RC,,,outpatient,,,39.75,19.88,,38.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,35.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,23.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,36.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,37.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,38.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,23.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.85,90,
MINOR PROCEDURE FEE,14000017,CDM,361,RC,,,outpatient,,,582.75,291.38,,565.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,349.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,524.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,524.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,349.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,424.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,397.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,349.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,470.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,470.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,516.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,386.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,472.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,536.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,553.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,565.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,378.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,349.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,349.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,349.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,524.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,349.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,349.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,524.48,
COLONOSCOPY /INTERMED,14000027,CDM,360,RC,,,outpatient,,,2002.25,1001.13,,1942.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,1201.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,600.68,30,,,percent of total billed charges,Pays at 30% of total billed charges,1802.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,1802.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,1201.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1456.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1366.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1201.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1616.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1616.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1774.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1327.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1621.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1842.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,1902.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,1942.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,1301.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,1201.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1201.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1201.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1802.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,1201.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1201.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1802.03,
BRAVO PLACEMENT ONLY,14000040,CDM,750,RC,,,outpatient,,,2008.25,1004.13,,1948,97,,,percent of total billed charges,Pays at 97% of total billed charges,1204.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,424.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1807.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,1807.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,1204.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1461.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1370.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1204.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1621.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1621.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1779.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1331.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1626.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1847.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,1907.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,1948,97,,,percent of total billed charges,Pays at 97% of total billed charges,1305.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,1204.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1204.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1204.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1807.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,1204.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1204.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1807.43,
CORE ROOM CHARGE,14000100,CDM,360,RC,,,outpatient,,,728.25,364.13,,706.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,436.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,655.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,655.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,436.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,529.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,497.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,436.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,587.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,587.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,645.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,482.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,589.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,669.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,691.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,706.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,473.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,436.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,436.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,436.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,655.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,436.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,436.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,655.43,
SURG PATH I,14000200,CDM,310,RC,,,outpatient,,,71.75,35.88,,69.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,58.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,66.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,68.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.05,102.86,
SURG PATH II,14000201,CDM,310,RC,,,outpatient,,,90,45,,87.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,81,90,,,percent of total billed charges,Pays at 90% of total billed charges,81,90,,,percent of total billed charges,Pays at 90% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,72.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,82.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,85.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,87.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,Pays at 90% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54,102.86,
SURG PATH III,14000202,CDM,310,RC,,,outpatient,,,62,31,,60.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,42.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,50.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,57.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,58.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,60.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.2,102.86,
Test of tissues for diagnosis of abnormalities,14000203,CDM,310,RC,,,outpatient,,,202.75,101.38,,196.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,138.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,163.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,179.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,134.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,164.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,186.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,192.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,196.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,182.48,
SURG PATH V,14000204,CDM,310,RC,,,outpatient,,,253.75,126.88,,246.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,152.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,189.98,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,228.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,228.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,173.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,152.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,204.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,204.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,224.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,168.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,205.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,233.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,241.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,246.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,152.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,152.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,228.38,
SURG PATH LEVEL VI TECH,14000205,CDM,310,RC,,,outpatient,,,367,183.5,,355.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,220.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,290.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,330.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,330.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,220.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,267.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,250.48,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,220.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,296.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,296.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,325.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,243.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,297.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,337.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,348.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,355.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,238.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,220.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,220.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,220.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,330.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,220.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,220.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,330.3,
DECALCIFICATION PROCED,14000206,CDM,310,RC,,,outpatient,,,45,22.5,,43.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,27,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,40.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,27,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,41.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,42.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,43.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,27,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,27,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,27,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27,102.86,
Blood test to assist with diagnosis,14000207,CDM,310,RC,,,outpatient,,,145.5,72.75,,141.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,99.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,117.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,96.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,133.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,138.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,141.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,87.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.95,
Blood test to assist with diagnosis,14000208,CDM,310,RC,,,outpatient,,,89.25,44.63,,86.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.6,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,80.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,72.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,82.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,84.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,86.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.55,102.86,
PATH CONSULT FROZEN SECT,14000210,CDM,310,RC,,,outpatient,,,188,94,,182.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,169.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,169.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,128.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,112.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,151.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,166.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,124.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,152.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,172.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,178.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,182.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,122.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,112.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,112.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,169.2,
Pathology test,14000212,CDM,310,RC,,,outpatient,,,106.5,53.25,,103.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,95.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,72.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,97.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
CYTOGENETICS /100-300,14000214,CDM,310,RC,,,outpatient,,,258.25,129.13,,250.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,39.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,232.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,187.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,176.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,208.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,228.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,171.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,,,,,Other,Not Separately reimbursable,237.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,245.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,250.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,167.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,232.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,51.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.19,232.43,
CYTOGENETICS /D PROBE,14000216,CDM,310,RC,,,outpatient,,,212.25,106.13,,205.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.42,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,191.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,191.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.42,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,154.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,144.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.42,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,171.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,171.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,140.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,,,,,Other,Not Separately reimbursable,195.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,201.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,205.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,137.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.42,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.42,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.42,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,191.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.42,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,21.42,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.42,191.03,
MORPHOMETRIC ALYSIS USING COMP TECH,14000218,CDM,310,RC,,,outpatient,,,463.5,231.75,,449.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,278.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,417.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,417.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,278.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,337.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,316.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,278.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,374.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,374.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,410.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,307.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,375.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,426.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,440.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,449.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,301.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,278.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,278.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,278.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,417.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,278.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,278.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,417.15,
CYTOGENETICS /D PROBE,14000220,CDM,310,RC,,,outpatient,,,208.25,104.13,,202,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.42,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,187.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.42,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,151.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,142.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.42,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,168.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,168.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,184.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,138.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,,,,,Other,Not Separately reimbursable,191.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,197.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,202,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.42,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.42,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.42,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,187.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.42,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,21.42,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,21.42,187.43,
CYTOGENETICS 100-300,14000222,CDM,310,RC,,,outpatient,,,214.5,107.25,,208.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,39.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,193.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,193.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,156.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,146.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,173.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,173.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,190.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,142.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,,,,,Other,Not Separately reimbursable,197.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,203.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,208.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,193.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,51.19,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,51.19,193.05,
COMPLEX CYSTOMETROGRAM,14000224,CDM,360,RC,,,outpatient,,,1434.75,717.38,,1391.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,860.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1291.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,1291.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,860.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1043.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,979.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,860.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1158.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1158.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1271.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,951.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1162.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1319.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,1363.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,1391.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,932.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,860.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,860.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,860.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1291.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,860.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,860.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1291.28,
A diagnostic test used to measure the flow of urine,14000226,CDM,360,RC,,,outpatient,,,229,114.5,,222.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,137.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.58,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,206.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,206.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,156.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,137.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,184.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,202.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,151.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,185.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,210.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,217.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,222.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,148.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,137.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,137.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,206.1,
ELECTROMYOGRAPHY STUDY,14000230,CDM,360,RC,,,outpatient,,,331.25,165.63,,321.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.29,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,298.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,298.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,241.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,226.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,267.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,267.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,293.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,219.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,268.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,304.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,314.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,321.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,215.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,298.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,198.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,298.13,
VP AP,14000232,CDM,360,RC,,,outpatient,,,446,223,,432.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,267.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.68,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,401.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,401.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,267.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,324.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,304.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,267.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,360.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,360.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,395.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,295.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,361.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,410.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,423.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,432.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,289.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,267.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,267.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,267.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,401.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,267.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,267.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,401.4,
FISH,14000234,CDM,310,RC,,,outpatient,,,258.25,129.13,,250.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,232.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,176.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,228.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,171.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,209.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,237.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,245.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,250.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,167.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,154.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,232.43,
"IN SITU HYBRID PER SPECIMEN, INITIAL SGL",14000236,CDM,310,RC,,,outpatient,,,218.75,109.38,,212.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,196.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,149.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,131.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,176.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,193.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,145.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,177.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,201.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,207.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,212.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,142.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,131.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,131.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,196.88,
"CYTOPATH EVAL, F REPORT",14000240,CDM,310,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.28,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
"MORPHOMETRIC ALYSIS, TUMOR W COMP TECH",14000242,CDM,310,RC,,,outpatient,,,538,269,,521.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,484.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,484.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,391.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,367.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,434.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,434.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,476.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,356.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,435.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,494.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,511.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,521.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,349.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,484.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,322.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,484.2,
Immunization administration by a medical assistant or nurse,14001002,CDM,771,RC,,,outpatient,,,28.25,14.13,,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,102.86,
Immunization administration by a medical assistant or nurse,14001004,CDM,771,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,102.86,
Immunization administration by a medical assistant or nurse,14001006,CDM,771,RC,,,outpatient,,,28.25,14.13,,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,102.86,
VACCINE ADMIN >1 EA,14001012,CDM,771,RC,,,outpatient,,,22.75,11.38,,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,102.86,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-same drug add on",14001026,CDM,361,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,102.86,
IV INF/HYD INIT 31 - 60 MIN MOD 59,14001028,CDM,361,RC,,,outpatient,,,226.25,113.13,,219.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,154.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,150,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,183.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,208.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,214.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,219.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,147.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,203.63,
IV HYD EA ADD HR-8 HR MOD 59,14001030,CDM,361,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",14001032,CDM,361,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",14001034,CDM,361,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
ADDTL SEQUENT INF UP-1HR MOD 59,14001036,CDM,361,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
IV INF/HYD INIT UP-1 HR MOD 59,14001038,CDM,361,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
THER INJ SQ OR IM MOD 59,14001040,CDM,361,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
THER INJ INTRA-ARTERIAL MOD 59,14001042,CDM,361,RC,,,outpatient,,,50.75,25.38,,49.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,41.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,46.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,48.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,49.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",14001044,CDM,361,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",14001046,CDM,361,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
PORT FLUSH ONLY,14001050,CDM,335,RC,,,outpatient,,,92.5,46.25,,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,74.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,102.86,
IV INF/HYD INIT UP-1 HR,14001064,CDM,361,RC,,,outpatient,,,218.75,109.38,,212.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,196.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,149.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,131.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,176.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,193.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,145.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,177.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,201.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,207.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,212.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,142.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,131.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,131.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,196.88,
IV HYD EA ADD HR-8 HR,14001066,CDM,361,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",14001068,CDM,361,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",14001070,CDM,361,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
THER INJ SQ OR IM,14001076,CDM,361,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",14001080,CDM,361,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",14001082,CDM,361,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
PORT FLUSH ONLY,14001084,CDM,335,RC,,,outpatient,,,138.5,69.25,,134.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,124.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,124.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,94.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,111.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,122.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,112.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,127.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,131.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,134.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,83.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,124.65,
IV INF/HYD INIT 31 - 60 MIN MOD XE,14001800,CDM,361,RC,,,outpatient,,,226.25,113.13,,219.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,154.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,150,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,183.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,208.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,214.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,219.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,147.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,203.63,
IV HYD EA ADD HR-8 HR MOD XE,14001801,CDM,361,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",14001802,CDM,361,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",14001803,CDM,361,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
ADDTL SEQUENT INF UP-1HR MOD XE,14001804,CDM,361,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
IV INF/HYD INIT UP-1 HR MOD XE,14001805,CDM,361,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
THER INJ SQ OR IM MOD XE,14001806,CDM,361,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",14001807,CDM,361,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",14001808,CDM,361,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-same drug add on",14001809,CDM,361,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,102.86,
IV INF/HYD INIT 31 - 60 MIN MOD XS,14001810,CDM,361,RC,,,outpatient,,,226.25,113.13,,219.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,154.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,150,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,183.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,208.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,214.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,219.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,147.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,203.63,
IV INF/HYD INIT 31 - 60 MIN MOD XS,14001811,CDM,361,RC,,,outpatient,,,226.25,113.13,,219.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,154.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,150,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,183.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,208.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,214.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,219.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,147.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,203.63,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",14001812,CDM,361,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",14001813,CDM,361,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
ADDTL SEQUENT INF UP-1HR MOD XS,14001814,CDM,361,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
IV INF/HYD INIT UP-1 HR MOD XS,14001815,CDM,361,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
THER INJ SQ OR IM MOD XS,14001816,CDM,361,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",14001817,CDM,361,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",14001818,CDM,361,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-same drug add on",14001819,CDM,361,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,102.86,
IV INF/HYD INIT 31 - 60 MIN MOD XU,14001820,CDM,361,RC,,,outpatient,,,226.25,113.13,,219.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,154.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,150,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,183.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,208.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,214.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,219.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,147.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,203.63,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",14001822,CDM,361,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",14001823,CDM,361,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
ADDTL SEQUENT INF UP-1HR MOD XU,14001824,CDM,361,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
IV INF/HYD INIT UP-1 HR MOD XU,14001825,CDM,361,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
THER INJ SQ OR IM MOD XU,14001826,CDM,361,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",14001827,CDM,361,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",14001828,CDM,361,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-same drug add on",14001829,CDM,361,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,102.86,
IV INF/HYD INIT 31 - 60 MIN MOD XP,14001830,CDM,361,RC,,,outpatient,,,226.25,113.13,,219.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,154.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,150,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,183.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,208.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,214.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,219.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,147.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,135.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,203.63,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",14001832,CDM,361,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",14001833,CDM,361,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
ADDTL SEQUENT INF UP-1HR MOD XP,14001834,CDM,361,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
IV INF/HYD INIT UP-1 HR MOD XP,14001835,CDM,361,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
THER INJ SQ OR IM MOD XP,14001836,CDM,361,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",14001837,CDM,361,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",14001838,CDM,361,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-same drug add on",14001839,CDM,361,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,102.86,
INSERT TUNNELED CV CATH OUTSIDE SERVICE,14036569,CDM,361,RC,,,outpatient,,,1723,861.5,,1671.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1550.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1550.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1253.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1175.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1390.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1390.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1526.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1142.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1395.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1585.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,1636.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,1671.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,1119.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1550.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1550.7,
VENOUS ACCESS DEVICE COLL BLOOD,14036591,CDM,361,RC,,,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.04,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,102.86,100,,,Case rate,pays at 100% of fixed rate,,,,,Other,Not Separately reimbursable,100,102.86,
MICROSATELLITE INSTABLITY ALYSIS,14081301,CDM,310,RC,,,outpatient,,,1074,537,,1041.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,348.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,271.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,966.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,966.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,348.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,781.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,733.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,348.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,866.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,866.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,951.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,712.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,,,,,Other,Not Separately reimbursable,988.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,1020.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,1041.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,698.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,348.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,348.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,348.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,966.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,348.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,348.56,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,90,966.6,
IMMUNOCYTOCHEM EA  ADDT'L SINGLE,14088341,CDM,310,RC,,,outpatient,,,106.5,53.25,,103.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,95.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,72.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,97.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Pathology test,14088344,CDM,310,RC,,,outpatient,,,106.5,53.25,,103.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,95.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,72.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,97.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
MANOMETRIC STUDY W INTERP AND REPORT,14091010,CDM,750,RC,,,outpatient,,,518.5,259.25,,502.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,466.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,466.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,377.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,353.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,418.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,418.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,459.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,343.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,419.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,477.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,492.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,502.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,337.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,466.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,466.65,
CPR,14092950,CDM,360,RC,,,outpatient,,,715.75,357.88,,694.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,429.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,295.77,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,644.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,644.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,429.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,520.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,488.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,429.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,577.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,577.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,634.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,474.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,579.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,658.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,679.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,694.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,465.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,429.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,429.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,429.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,644.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,429.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,429.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,644.18,
ADDTL SEQUENT INF UP-1HR,14096367,CDM,361,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
Outpatient visit of established patient not requiring a physician,14099211,CDM,510,RC,,,outpatient,,,42.75,21.38,,41.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,39.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,25.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,102.86,
EXCISION BEN > 4.0 CM,14111406,CDM,361,RC,,,outpatient,,,388.5,194.25,,376.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,233.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,349.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,349.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,233.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,282.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,265.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,233.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,313.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,344.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,257.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,314.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,357.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,369.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,376.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,252.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,233.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,233.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,233.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,349.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,233.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,233.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,349.65,
LAYER WOUND 7.6-12.5,14112034,CDM,361,RC,,,outpatient,,,344,172,,333.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,206.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,296.66,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,309.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,309.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,206.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,234.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,206.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,277.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,277.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,304.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,228.07,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,278.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,316.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,326.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,333.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,223.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,206.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,309.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,206.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,206.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,309.6,
Laser removal of incompetent vein,14136478,CDM,510,RC,,,outpatient,,,2911.5,1455.75,,2824.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,1746.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1013.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2620.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,2620.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,1746.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2118.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1987.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1746.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2350.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2350.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2579.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1930.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2358.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2678.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,2765.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,2824.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,1892.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,1746.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1746.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1746.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2620.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,1746.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1746.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2620.35,
RECOVERY ROOM FIRST 30 MIN,14200001,CDM,710,RC,,,outpatient,,,557,278.5,,540.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,334.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,501.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,501.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,334.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,405.27,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,380.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,334.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,449.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,449.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,493.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,369.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,451.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,512.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,529.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,540.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,362.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,334.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,334.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,334.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,501.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,334.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,334.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,501.3,
RECOVERY ROOM EA MINUTE AFTER 30,14200003,CDM,710,RC,,,outpatient,,,12,6,,11.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,9.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,11.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,
Sleep monitoring of patient (6 years or older) in sleep lab using CPAP,14600002,CDM,920,RC,,,outpatient,,,2691.5,1345.75,,2610.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,1614.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,566.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2422.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,2422.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,1614.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1958.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1836.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1614.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2172.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2172.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2384.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1784.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2180.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2476.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,2556.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,2610.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,1749.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,1614.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1614.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1614.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2422.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,1614.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1614.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2422.35,
Sleep monitoring of patient (6 years or older) in sleep lab,14600004,CDM,920,RC,,,outpatient,,,2399.75,1199.88,,2327.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,1439.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,540.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2159.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,2159.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,1439.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1746.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1637.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1439.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1937.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1937.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2126.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1591.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1943.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2207.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,2279.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,2327.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,1559.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,1439.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1439.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1439.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2159.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,1439.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1439.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2159.78,
SLEEP STUDY MSLT TECH,14600006,CDM,920,RC,,,outpatient,,,1818.75,909.38,,1764.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,1091.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,367.2,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1636.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,1636.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,1091.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1323.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1241.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1091.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1468.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1468.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1611.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1205.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1473.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1673.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,1727.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,1764.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,1182.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,1091.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1091.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1091.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1636.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,1091.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1091.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1636.88,
SC EEG 41-60 MINUTES AWAKE TECH,14605812,CDM,740,RC,,,outpatient,,,702.25,351.13,,681.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,421.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,284.86,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,632.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,632.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,421.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,510.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,479.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,421.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,566.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,566.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,622.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,465.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,568.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,646.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,667.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,681.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,456.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,421.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,632.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,421.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,421.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,632.03,
SC EEG 61-119 MINUTES AWAKE TECH,14605813,CDM,740,RC,,,outpatient,,,838,419,,812.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,502.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,355.75,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,754.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,754.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,502.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,609.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,571.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,502.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,676.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,676.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,742.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,555.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,678.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,770.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,796.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,812.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,544.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,502.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,502.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,502.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,754.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,502.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,502.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,754.2,
SC EEG AWAKE DROWSY TECH,14605816,CDM,740,RC,,,outpatient,,,546.5,273.25,,530.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,327.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,317.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,491.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,491.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,327.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,397.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,372.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,327.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,441.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,441.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,484.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,362.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,442.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,502.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,519.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,530.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,355.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,327.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,327.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,327.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,491.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,327.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,327.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,491.85,
SC EEG AWAKE  ASLEEP TECH,14605819,CDM,740,RC,,,outpatient,,,703.25,351.63,,682.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,372.64,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,632.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,632.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,511.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,479.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,567.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,567.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,623.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,466.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,569.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,646.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,668.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,682.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,457.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,632.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,421.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,632.93,
EEG W/O VIDEO 2-12 HRS CONT MONITORING,14695707,CDM,740,RC,,,outpatient,,,1005.75,502.88,,975.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,603.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,301.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,905.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,905.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,603.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,731.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,686.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,603.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,811.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,811.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,891.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,666.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,814.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,925.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,955.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,975.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,653.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,603.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,603.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,603.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,905.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,603.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,603.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,905.18,
EEG W VIDEO (VEEG) 2-12 HRS CONT MONITOR,14695713,CDM,740,RC,,,outpatient,,,1207,603.5,,1170.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,724.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,362.1,30,,,percent of total billed charges,Pays at 30% of total billed charges,1086.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1086.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,724.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,878.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,823.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,724.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,974.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,974.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1069.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,800.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,977.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1110.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,1146.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,1170.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,784.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,724.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,724.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,724.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1086.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,724.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,724.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1086.3,
POLYSOMNOGRAPHY <6YRS > 4 PARAMETER TECH,14695782,CDM,920,RC,,,outpatient,,,2642.5,1321.25,,2563.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,1585.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,793.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2378.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,2378.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1585.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1922.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1803.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1585.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2133.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2133.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2341.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1751.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2140.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2431.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,2510.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,2563.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,1717.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,1585.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1585.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1585.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2378.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,1585.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1585.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2378.25,
HOME SLEEP STUDY TECH,14695806,CDM,920,RC,,,outpatient,,,311.5,155.75,,302.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,186.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.52,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,280.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,280.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,186.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,212.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,186.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,251.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,276.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,206.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,252.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,286.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,295.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,302.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,202.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,186.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,280.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,186.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,186.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,280.35,
Outpatient visit of established patient not requiring a physician,14699211,CDM,510,RC,,,outpatient,,,26.75,13.38,,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,102.86,
Outpatient visit of established patient requiring a physician,14699212,CDM,510,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,102.86,
"Established patient office or other outpatient visit, typically 15 minutes",14699213,CDM,510,RC,,,outpatient,,,40,20,,38.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,24,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,36,90,,,percent of total billed charges,Pays at 90% of total billed charges,36,90,,,percent of total billed charges,Pays at 90% of total billed charges,24,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,36.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,38,95,,,percent of total billed charges,Pays at 95% of total billed charges,38.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,26,65,,,percent of total billed charges,Pays at 65% of total billed charges,24,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36,90,,,percent of total billed charges,Pays at 90% of total billed charges,24,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,24,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24,102.86,
"Established patient office or other outpatient visit, typically 25 minutes",14699214,CDM,510,RC,,,outpatient,,,65.5,32.75,,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,53.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,60.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,62.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,102.86,
"Established patient office or other outpatient, visit typically 40 minutes",14699215,CDM,510,RC,,,outpatient,,,98.75,49.38,,95.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,88.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,59.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,79.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,90.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,93.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,95.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,59.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,59.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.25,102.86,
ER BASIC 1,14800001,CDM,450,RC,,,outpatient,,,144.5,72.25,,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.05,
ER BASIC 1,14800002,CDM,450,RC,,,outpatient,,,144.5,72.25,,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.05,
ER BASIC 2,14800003,CDM,450,RC,,,outpatient,,,225,112.5,,218.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,202.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,153.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,181.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,199.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,182.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,207,92,,,percent of total billed charges,Pays at 92% of total billed charges,213.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,218.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,202.5,
ER BASIC 2,14800004,CDM,450,RC,,,outpatient,,,225,112.5,,218.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,202.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,153.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,181.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,199.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,182.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,207,92,,,percent of total billed charges,Pays at 92% of total billed charges,213.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,218.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,202.5,
"Emergency department visit, moderately severe problem",14800005,CDM,450,RC,,,outpatient,,,372,186,,360.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,223.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.71,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,334.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,334.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,223.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,270.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,253.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,223.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,300.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,300.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,329.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,246.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,301.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,342.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,353.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,360.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,241.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,223.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,334.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,223.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,223.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,334.8,
"Emergency department visit, moderately severe problem",14800006,CDM,450,RC,,,outpatient,,,372,186,,360.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,223.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.71,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,334.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,334.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,223.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,270.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,253.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,223.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,300.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,300.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,329.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,246.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,301.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,342.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,353.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,360.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,241.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,223.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,334.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,223.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,223.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,334.8,
"Emergency department visit, problem of high severity",14800007,CDM,450,RC,,,outpatient,,,585.5,292.75,,567.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,351.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,526.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,526.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,351.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,426.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,399.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,351.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,472.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,472.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,518.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,388.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,474.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,538.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,556.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,567.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,380.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,351.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,351.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,351.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,526.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,351.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,351.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,526.95,
"Emergency department visit, problem of high severity",14800008,CDM,450,RC,,,outpatient,,,585.5,292.75,,567.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,351.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,526.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,526.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,351.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,426.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,399.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,351.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,472.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,472.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,518.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,388.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,474.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,538.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,556.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,567.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,380.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,351.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,351.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,351.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,526.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,351.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,351.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,526.95,
CRITICAL CARE (LEVEL VI) EA ADD 30 MIN,14800009,CDM,450,RC,,,outpatient,,,374.75,187.38,,363.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,337.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,337.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,272.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,255.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,302.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,302.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,332.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,248.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,303.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,344.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,356.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,363.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,243.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,337.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,224.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,337.28,
CRITICAL CARE (LEVEL 6)30-74 MIN,14800010,CDM,450,RC,,,outpatient,,,1557.25,778.63,,1510.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,934.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,257.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1401.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,1401.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,934.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1133.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1062.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,934.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1257.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1257.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1379.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1032.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1261.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1432.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,1479.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,1510.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,1012.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,934.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,934.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,934.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1401.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,934.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,934.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1401.53,
CRITICAL CARE (LEVEL 6)30-74 MIN,14800011,CDM,450,RC,,,outpatient,,,1557.25,778.63,,1510.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,934.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,257.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1401.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,1401.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,934.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1133.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1062.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,934.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1257.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1257.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1379.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1032.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1261.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1432.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,1479.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,1510.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,1012.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,934.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,934.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,934.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1401.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,934.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,934.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1401.53,
ET PFIZER COVID 19 VAC ADMIN 1ST DOSE,14800019,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
ET PFIZER COVID 19 VAC ADMIN 3RD DOSE,14800025,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
ET PFIZER COVID 19 VAC ADMIN 2ND DOSE,14800029,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
DRESS DEBRIDE BURN LG,14800038,CDM,450,RC,,,outpatient,,,254.5,127.25,,246.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,152.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,179.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,229.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,229.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,173.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,152.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,205.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,225.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,168.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,206.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,234.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,241.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,246.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,165.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,152.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,229.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,152.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,229.05,
Draining or injecting medication into a large joint/bursa without ultrasound,14800044,CDM,450,RC,,,outpatient,,,138.25,69.13,,134.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,124.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,124.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,94.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,111.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,122.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,127.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,131.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,134.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,124.43,
ET PFIZER COVID 19 VAC ADMIN BOOSTER,14800049,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
FORENSIC MEDICAL EXAM,14800100,CDM,450,RC,,,outpatient,,,509.5,254.75,,494.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,458.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,458.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,347.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,411.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,411.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,451.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,337.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,412.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,468.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,484.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,494.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,331.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,458.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,458.55,
ER CPR,14800101,CDM,450,RC,,,outpatient,,,715.5,357.75,,694.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,429.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,295.77,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,643.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,643.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,429.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,520.6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,488.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,429.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,577.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,577.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,634,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,474.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,579.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,658.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,679.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,694.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,465.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,429.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,429.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,429.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,643.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,429.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,429.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,643.95,
"Emergency department visit, problem with significant threat to life or function",14800103,CDM,450,RC,,,outpatient,,,930.75,465.38,,902.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,558.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,837.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,837.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,558.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,677.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,635.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,558.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,751.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,751.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,824.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,617.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,753.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,856.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,884.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,902.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,604.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,558.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,558.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,558.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,837.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,558.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,558.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,837.68,
"Emergency department visit, problem with significant threat to life or function",14800104,CDM,450,RC,,,outpatient,,,930.75,465.38,,902.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,558.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,837.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,837.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,558.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,677.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,635.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,558.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,751.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,751.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,824.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,617.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,753.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,856.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,884.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,902.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,604.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,558.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,558.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,558.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,837.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,558.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,558.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,837.68,
Immunization administration by a medical assistant or nurse,14800108,CDM,771,RC,,,outpatient,,,28.25,14.13,,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,102.86,
IMMUNIZATION ADMIN ADDTL,14800110,CDM,771,RC,,,outpatient,,,22.75,11.38,,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,102.86,
Outpatient visit of established patient not requiring a physician,14800111,CDM,761,RC,,,outpatient,,,43,21.5,,41.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,38.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,39.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,25.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.8,102.86,
Outpatient visit of established patient requiring a physician,14800112,CDM,761,RC,,,outpatient,,,181.75,90.88,,176.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,163.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,124.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,161.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,147.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,167.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,176.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.58,
"Established patient office or other outpatient visit, typically 15 minutes",14800113,CDM,761,RC,,,outpatient,,,145,72.5,,140.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,87,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,87,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,87,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,117.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,96.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,133.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,87,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,87,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,87,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.5,
"Established patient office or other outpatient visit, typically 25 minutes",14800114,CDM,761,RC,,,outpatient,,,199.25,99.63,,193.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,119.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,179.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,179.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,135.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,119.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,176.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,132.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,161.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,183.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,189.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,193.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,129.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,119.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,179.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,119.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,179.33,
"Established patient office or other outpatient, visit typically 40 minutes",14800115,CDM,761,RC,,,outpatient,,,266.25,133.13,,258.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,239.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,239.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,181.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,214.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,235.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,176.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,215.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,244.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,252.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,258.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,173.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,239.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,159.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,239.63,
REPAIR TONGUE LACERATION,14800117,CDM,450,RC,,,outpatient,,,271.5,135.75,,263.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,162.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.38,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,244.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,244.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,162.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.54,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,185.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,162.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,219.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,219.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,240.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,180,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,219.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,249.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,257.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,263.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,176.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,162.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,244.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,162.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,162.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,244.35,
TRT TOE FX,14800119,CDM,450,RC,,,outpatient,,,188.75,94.38,,183.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,169.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,169.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,128.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,113.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,167.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,125.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,152.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,173.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,179.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,183.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,122.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,113.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,113.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,169.88,
Incision and draige of abscess; simple or single and complex or multiple,14800120,CDM,450,RC,,,outpatient,,,203,101.5,,196.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.18,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,182.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,138.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,163.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,179.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,134.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,164.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,186.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,192.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,196.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,121.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,182.7,
INC/REM FOREIGN BDY /SIMP,14800122,CDM,450,RC,,,outpatient,,,240.75,120.38,,233.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,216.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,216.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,175.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,164.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,194.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,213.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,159.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,195.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,221.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,228.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,233.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,156.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,216.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,216.68,
"Puncture aspiration of abscess, hematoma, bulla, or cyst",14800124,CDM,450,RC,,,outpatient,,,206,103,,199.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,123.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,185.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,185.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,140.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,123.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,166.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,136.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,166.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,189.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,195.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,199.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,133.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,123.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,123.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,185.4,
DEBRIDE SKIN /SUB TISSUE,14800126,CDM,450,RC,,,outpatient,,,298,149,,289.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.69,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,268.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,268.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,178.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,216.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,203.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,178.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,240.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,240.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,264.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,197.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,241.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,274.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,283.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,289.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,193.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,178.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,268.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,178.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,178.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,268.2,
Separation and removal of the entire il plate or a portion of il plate,14800128,CDM,450,RC,,,outpatient,,,212,106,,205.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,190.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,190.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,144.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,171.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,187.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,140.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,171.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,195.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,201.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,205.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,137.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,127.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,190.8,
ET MODER COVID 19 VAC ADMIN 2ND DOSE,14800129,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
EVAC SUB HEMATOMA,14800130,CDM,450,RC,,,outpatient,,,68,34,,65.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,61.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,45.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,55.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,62.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,65.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.8,102.86,
EXCISION OF IL,14800132,CDM,450,RC,,,outpatient,,,328,164,,318.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.25,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,295.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,295.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,223.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,264.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,264.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,290.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,217.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,265.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,301.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,311.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,318.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,295.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,295.2,
REPAIR IL BED,14800134,CDM,450,RC,,,outpatient,,,306,153,,296.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,183.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,179.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,275.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,275.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,183.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,208.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,183.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,247,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,271.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,202.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,247.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,281.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,290.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,296.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,198.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,183.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,275.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,183.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,183.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,275.4,
WEDGE EXCISION SKIN,14800136,CDM,450,RC,,,outpatient,,,323.25,161.63,,313.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,193.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,290.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,290.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,193.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,220.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,193.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,260.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,260.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,286.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,214.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,261.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,297.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,307.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,313.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,210.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,193.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,290.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,193.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,193.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,290.93,
"Simple repair of superficial wounds of scalp, neck, axillae, exterl genitalia, trunk and/or extremities",14800138,CDM,450,RC,,,outpatient,,,249.25,124.63,,241.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,224.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,170.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,201.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,220.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,165.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,201.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,229.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,236.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,241.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,162.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,224.33,
ET MODER COVID 19 VAC ADMIN 3RD DOSE,14800139,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
SIMPLE WOUND 2.6-7.5,14800140,CDM,450,RC,,,outpatient,,,267.25,133.63,,259.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,160.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,240.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,240.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,160.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,182.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,160.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,215.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,236.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,177.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,216.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,245.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,253.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,259.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,173.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,160.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,240.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,160.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,160.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,240.53,
SIMPLE WOUND 7.6-12.5,14800142,CDM,450,RC,,,outpatient,,,312.5,156.25,,303.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,187.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,281.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,281.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,227.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,213.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,187.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,252.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,276.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,207.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,253.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,287.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,296.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,303.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,203.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,187.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,281.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,187.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,187.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,281.25,
SIMPLE WOUND 12.6-20.0,14800144,CDM,450,RC,,,outpatient,,,388,194,,376.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,232.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.09,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,349.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,349.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,282.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,264.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,232.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,313.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,343.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,257.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,314.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,356.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,368.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,376.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,252.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,232.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,349.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,232.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,349.2,
"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes",14800146,CDM,450,RC,,,outpatient,,,264.75,132.38,,256.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,158.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.1,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,238.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,238.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,158.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,180.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,158.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,213.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,234.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,175.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,214.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,243.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,251.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,256.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,172.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,158.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,158.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,158.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,238.28,
SIMPLE WOUND 2.6-5.0,14800148,CDM,450,RC,,,outpatient,,,291.5,145.75,,282.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,198.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,235.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,258.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,193.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,236.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,268.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,276.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,282.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,189.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,262.35,
SIMPLE WOUND 5.1-7.5,14800150,CDM,450,RC,,,outpatient,,,342.75,171.38,,332.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,205.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.78,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,308.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,308.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,205.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,249.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,233.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,205.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,276.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,276.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,303.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,227.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,277.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,315.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,325.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,332.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,222.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,205.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,205.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,205.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,308.48,
TRT SUPERFICIAL /SIMPLE,14800152,CDM,450,RC,,,outpatient,,,357.25,178.63,,346.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,214.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,267.13,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,321.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,321.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,214.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,243.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,214.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,288.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,288.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,316.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,236.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,289.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,328.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,339.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,346.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,232.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,214.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,321.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,214.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,214.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,321.53,
LAYER WOUND 2.5,14800154,CDM,450,RC,,,outpatient,,,266,133,,258.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,159.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.18,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,239.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,239.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.54,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,181.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,159.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,214.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,235.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,176.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,215.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,244.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,252.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,258.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,172.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,159.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,239.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,159.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,159.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,239.4,
LAYER WOUND 2.6-7.5,14800156,CDM,450,RC,,,outpatient,,,364.5,182.25,,353.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,280.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,328.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,328.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,265.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,248.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,294.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,294.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,322.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,241.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,295.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,335.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,346.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,353.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,236.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,328.05,
LAYER WOUND 7.6-12.5,14800158,CDM,450,RC,,,outpatient,,,356.25,178.13,,345.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,296.66,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,320.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,243.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,315.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,236.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,288.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,327.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,338.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,345.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,231.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,320.63,
LAYER WOUND 2.6-7.5,14800160,CDM,450,RC,,,outpatient,,,344.25,172.13,,333.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,206.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,275,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,309.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,309.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,206.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,234.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,206.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,277.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,277.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,305.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,228.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,278.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,316.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,327.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,333.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,223.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,206.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,309.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,206.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,206.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,309.83,
LAYER WOUND 2.6-5.0,14800162,CDM,450,RC,,,outpatient,,,349.75,174.88,,339.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,209.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,279.8,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,314.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,314.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,238.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,209.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,282.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,282.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,309.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,231.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,283.3,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,321.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,332.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,339.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,227.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,209.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,314.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,209.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,209.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,314.78,
BURN INT 1ST DEGREE,14800164,CDM,450,RC,,,outpatient,,,141,70.5,,136.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,126.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,126.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,124.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,133.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,136.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,84.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,126.9,
DRESS/DEBR BURN SMALL,14800168,CDM,450,RC,,,outpatient,,,161,80.5,,156.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,144.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,144.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,109.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,129.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,106.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,130.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,148.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,152.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,156.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,144.9,
DRESS/DEBR BURN MED,14800170,CDM,450,RC,,,outpatient,,,298,149,,289.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.76,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,268.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,268.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,178.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,216.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,203.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,178.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,240.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,240.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,264.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,197.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,241.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,274.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,283.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,289.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,193.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,178.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,268.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,178.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,178.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,268.2,
Draining or injecting medication into a major joint/bursa without ultrasound,14800172,CDM,450,RC,,,outpatient,,,145,72.5,,140.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,87,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,87,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,87,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,117.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,96.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,133.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,87,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,87,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,87,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.5,
REM FORG BODY FOOT SUB,14800174,CDM,450,RC,,,outpatient,,,402.25,201.13,,390.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,241.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,362.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,362.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,241.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,292.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,274.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,241.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,324.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,324.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,356.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,266.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,325.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,370.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,382.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,390.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,261.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,241.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,241.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,241.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,362.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,241.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,241.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,362.03,
REMOVE FOR BODY SAL,14800176,CDM,450,RC,,,outpatient,,,218.75,109.38,,212.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,196.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,159.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,149.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,131.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,176.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,193.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,145.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,177.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,201.25,92,,,percent of total billed charges,Pays at 92% of total billed charges,207.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,212.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,142.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,131.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,131.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,196.88,
SAL HEMOR /ANTER SIMPLE UNILATERAL,14800178,CDM,450,RC,,,outpatient,,,176,88,,170.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.23,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,116.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,142.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,161.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,170.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,158.4,
INTUBATION ENDOTREAC,14800180,CDM,450,RC,,,outpatient,,,194.25,97.13,,188.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,174.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,132.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,156.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,172.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,128.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,157.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,178.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,184.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,188.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,126.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,116.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,174.83,
SPIL PUNC LUMB DIAG,14800188,CDM,450,RC,,,outpatient,,,356.25,178.13,,345.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,320.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,320.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,243.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,287.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,315.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,236.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,288.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,327.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,338.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,345.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,231.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,213.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,320.63,
CLSD TRT ACROMIOCLAVICULAR DISLOCATION,14800190,CDM,450,RC,,,outpatient,,,128.5,64.25,,124.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,216.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,87.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,85.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,104.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,118.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,122.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,124.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,115.65,
SIMPLE WOUND 7.6-12.5 CM,14800196,CDM,450,RC,,,outpatient,,,430.25,215.13,,417.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,258.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.14,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,387.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,387.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,258.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,293.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,258.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,347.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,347.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,381.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,285.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,348.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,395.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,408.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,417.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,279.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,258.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,258.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,258.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,387.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,258.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,258.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,387.23,
RMV FB CONJUNCTIVA,14800198,CDM,450,RC,,,outpatient,,,240.75,120.38,,233.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.13,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,216.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,216.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,175.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,164.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,194.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,213.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,159.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,195.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,221.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,228.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,233.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,156.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,216.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,216.68,
ET MODER COVID 19 VAC ADMIN 1ST DOSE,14800199,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
REMOVE FOR BODY CORNEA,14800200,CDM,450,RC,,,outpatient,,,199,99.5,,193.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,119.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.52,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,179.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,179.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,135.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,119.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,160.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,176.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,131.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,161.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,183.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,189.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,193.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,129.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,119.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,179.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,119.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,119.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,179.1,
RMV FB EXT EYE,14800202,CDM,450,RC,,,outpatient,,,195.5,97.75,,189.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,175.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,175.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.25,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,133.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,117.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,157.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,173.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,129.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,158.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,179.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,185.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,189.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,127.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,117.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,175.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,117.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,175.95,
DRAIN MOUTH LESION,14800203,CDM,450,RC,,,outpatient,,,128.5,64.25,,124.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,87.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,85.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,104.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,118.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,122.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,124.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,115.65,
APPLY SHORT LEG CAST,14800207,CDM,450,RC,,,outpatient,,,159,79.5,,154.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.18,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,143.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,143.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,108.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,95.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,140.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,105.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,128.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,146.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,151.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,154.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,95.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,95.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,143.1,
SAL HEMOR COMPLEX,14800208,CDM,450,RC,,,outpatient,,,255.75,127.88,,248.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,153.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.64,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,230.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,230.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,153.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,174.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,153.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,206.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,169.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,207.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,235.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,242.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,248.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,166.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,153.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,153.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,153.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,230.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,153.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,153.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,230.18,
"TRT FINGER FRACTURE, EACH",14800210,CDM,450,RC,,,outpatient,,,303.5,151.75,,294.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,352.29,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,273.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,273.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,220.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,207.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,182.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,244.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,244.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,268.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,201.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,245.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,279.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,288.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,294.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,197.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,182.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,182.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,273.15,
PARACENTESIS,14800216,CDM,450,RC,,,outpatient,,,496.25,248.13,,481.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,446.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,446.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,361.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,338.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,400.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,439.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,329.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,401.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,456.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,471.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,481.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,322.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,446.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,446.63,
CL TRT DIS FING W/O ANES,14800218,CDM,450,RC,,,outpatient,,,328,164,,318.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,312.09,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,295.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,295.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,223.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,264.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,264.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,290.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,217.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,265.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,301.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,311.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,318.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,295.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,295.2,
APPLY FOREARM SPLINT,14800222,CDM,450,RC,,,outpatient,,,128.5,64.25,,124.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,87.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,85.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,104.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,118.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,122.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,124.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,115.65,
TRT BIG TOE FX,14800224,CDM,450,RC,,,outpatient,,,220.75,110.38,,214.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.94,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,198.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,198.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,150.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,178.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,195.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,146.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,178.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,203.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,209.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,214.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,143.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,132.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,198.68,
APPLY FINGER SPLINT,14800226,CDM,450,RC,,,outpatient,,,94,47,,91.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,84.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,64.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,62.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,76.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,86.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,89.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,91.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,56.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.4,102.86,
CLSD TRT DISTAL W/MAN,14800230,CDM,450,RC,,,outpatient,,,797.5,398.75,,773.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,478.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,489.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,717.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,717.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,478.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,580.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,544.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,478.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,643.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,643.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,706.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,528.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,645.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,733.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,757.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,773.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,518.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,478.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,478.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,478.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,717.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,478.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,478.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,717.75,
APP SHT LEG SPLINT,14800232,CDM,450,RC,,,outpatient,,,114.25,57.13,,110.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,102.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,102.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,75.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,92.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,105.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,108.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,110.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
APP FINGER SPINT STCT,14800234,CDM,450,RC,,,outpatient,,,204.5,102.25,,198.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,122.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.02,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,184.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,184.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,122.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,139.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,122.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,165.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,181.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,135.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,165.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,188.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,194.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,198.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,132.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,122.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,122.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,122.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,184.05,
TRT THUMB DISLOCATION,14800236,CDM,450,RC,,,outpatient,,,465.75,232.88,,451.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,279.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,355.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,419.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,419.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,279.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,338.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,317.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,279.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,375.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,375.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,412.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,308.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,377.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,428.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,442.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,451.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,302.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,279.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,279.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,279.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,419.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,279.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,279.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,419.18,
Removal of ear wax from one or both ears,14800238,CDM,450,RC,,,outpatient,,,68,34,,65.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,61.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,45.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,55.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,62.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,65.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,40.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.8,102.86,
LAYER CL FACE ETS < 2.5,14800242,CDM,450,RC,,,outpatient,,,327,163.5,,317.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,196.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,245.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,294.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,294.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,237.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,223.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,196.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,263.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,263.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,289.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,216.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,264.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,300.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,310.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,317.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,212.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,196.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,196.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,294.3,
IV INFUSION CASIRIVIMAB/IMA INF/POST MON,14800243,CDM,450,RC,,,outpatient,,,931.5,465.75,,903.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,558.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,279.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,838.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,838.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,558.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,677.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,635.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,558.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,751.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,751.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,825.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,617.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,754.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,856.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,884.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,903.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,605.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,558.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,558.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,558.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,838.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,558.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,558.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,838.35,
CLSD TRT SHD DIS W ANES,14800244,CDM,450,RC,,,outpatient,,,728.25,364.13,,706.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,436.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,388.35,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,655.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,655.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,436.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,529.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,497.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,436.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,587.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,587.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,645.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,482.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,589.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,669.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,691.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,706.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,473.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,436.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,436.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,436.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,655.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,436.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,436.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,655.43,
IV INFUSION BAMLAN/ESTESEV INF/POST MON,14800245,CDM,450,RC,,,outpatient,,,931.5,465.75,,903.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,558.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,279.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,838.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,838.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,558.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,677.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,635.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,558.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,751.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,751.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,825.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,617.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,754.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,856.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,884.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,903.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,605.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,558.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,558.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,558.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,838.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,558.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,558.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,838.35,
APPLY FOREARM CAST,14800250,CDM,450,RC,,,outpatient,,,144,72,,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,116.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,136.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,129.6,
"Incision and draige of hematoma, seroma or fluid collection",14800252,CDM,450,RC,,,outpatient,,,2163.75,1081.88,,2098.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,1298.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1947.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,1947.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,1298.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1574.34,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1476.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1298.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1746.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1746.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1917.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1434.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1752.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1990.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,2055.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,2098.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,1406.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,1298.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1298.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1298.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1947.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,1298.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1298.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1947.38,
TRT METACARP FX,14800254,CDM,450,RC,,,outpatient,,,328,164,,318.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,303.2,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,295.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,295.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,223.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,264.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,264.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,290.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,217.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,265.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,301.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,311.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,318.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,295.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,295.2,
REMOVE FB EAR CAL,14800256,CDM,450,RC,,,outpatient,,,168,84,,162.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.66,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,151.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,151.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,114.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,135.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,111.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,136.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,154.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,159.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,162.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,100.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,151.2,
TRIM SKIN LESION,14800268,CDM,450,RC,,,outpatient,,,75,37.5,,72.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.2,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,67.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,49.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,60.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,69,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,72.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45,102.86,
TRT ANKLE FX,14800270,CDM,450,RC,,,outpatient,,,411.25,205.63,,398.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,246.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,294.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,370.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,370.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,246.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,280.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,246.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,331.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,331.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,364.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,272.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,333.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,378.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,390.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,398.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,267.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,246.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,246.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,246.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,246.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,246.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,370.13,
TRT FX RADIUS/UL,14800272,CDM,450,RC,,,outpatient,,,377.5,188.75,,366.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,226.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,291.77,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,339.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,339.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,226.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,274.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,257.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,226.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,304.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,304.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,334.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,250.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,305.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,347.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,358.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,366.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,245.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,226.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,339.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,226.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,226.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,339.75,
CATH /INDWELLING /COMP,14800274,CDM,450,RC,,,outpatient,,,224,112,,217.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,134.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.32,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,201.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.98,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,152.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,134.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,180.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,198.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,148.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,181.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,206.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,212.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,217.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,145.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,134.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,134.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,201.6,
CATH /INDWELLING /SIMPLE,14800276,CDM,450,RC,,,outpatient,,,135.25,67.63,,131.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.57,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,121.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,92.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,109.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,124.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,131.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.73,
CATH /NONDWELLING,14800278,CDM,450,RC,,,outpatient,,,108.75,54.38,,105.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,97.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,74.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,72.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,88.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,100.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,103.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,105.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,65.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Removal of fluid or injection of medication into a ganglion cyst,14800280,CDM,450,RC,,,outpatient,,,101.5,50.75,,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.69,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,82.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,93.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
TRT TOE DISLOCATION,14800292,CDM,450,RC,,,outpatient,,,249.25,124.63,,241.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,224.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,170.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,201.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,220.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,165.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,201.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,229.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,236.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,241.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,162.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,224.33,
APPLY LONG LEG SPLINT,14800294,CDM,450,RC,,,outpatient,,,128.5,64.25,,124.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,87.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,85.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,104.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,118.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,122.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,124.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,115.65,
LAYER CLOSE WOUND,14800302,CDM,450,RC,,,outpatient,,,291.5,145.75,,282.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,198.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,235.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,258.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,193.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,236.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,268.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,276.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,282.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,189.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,262.35,
TRT METACARPAL FX,14800304,CDM,450,RC,,,outpatient,,,342.75,171.38,,332.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,205.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273.75,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,308.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,308.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,205.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,249.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,233.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,205.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,276.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,276.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,303.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,227.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,277.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,315.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,325.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,332.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,222.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,205.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,205.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,205.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,308.48,
TRT FINGER DISLOCATION,14800306,CDM,450,RC,,,outpatient,,,291.5,145.75,,282.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.9,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,198.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,235.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,258.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,193.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,236.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,268.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,276.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,282.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,189.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,262.35,
Removal of infected skin,14800310,CDM,450,RC,,,outpatient,,,130.25,65.13,,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,88.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,105.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,119.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,123.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,78.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117.23,
TRT FX RADIUS/UL,14800312,CDM,450,RC,,,outpatient,,,484,242,,469.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,290.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,644.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,435.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,435.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,290.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,352.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,330.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,290.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,390.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,390.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,428.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,320.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,392.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,445.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,459.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,469.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,314.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,290.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,290.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,290.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,435.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,290.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,290.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,435.6,
TRT METATARSAL FX,14800314,CDM,450,RC,,,outpatient,,,284.75,142.38,,276.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,170.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,204.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,256.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,256.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,170.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,194.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,170.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,229.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,229.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,252.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,188.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,230.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,261.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,270.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,276.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,185.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,170.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,256.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,170.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,170.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,256.28,
THROMB IV COR ART,14800316,CDM,450,RC,,,outpatient,,,362,181,,351.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,217.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.77,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,325.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,325.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,217.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,263.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,247.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,217.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,292.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,292.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,320.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,240.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,293.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,333.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,343.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,351.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,235.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,217.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,217.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,217.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,325.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,217.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,217.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,325.8,
APP LONG ARM CAST,14800318,CDM,450,RC,,,outpatient,,,155.25,77.63,,150.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,139.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,93.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,105.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,93.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,137.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,102.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,125.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,142.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,147.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,150.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,93.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,93.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,93.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,139.73,
ET JANSSEN COVID 19 VAC ADMIN,14800319,CDM,771,RC,,,outpatient,,,88.25,44.13,,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,81.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,90,
CLSD TRT SAL FX,14800320,CDM,450,RC,,,outpatient,,,414,207,,401.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,248.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,372.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,372.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,248.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,301.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,282.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,248.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,334.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,334.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,366.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,274.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,335.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,380.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,393.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,401.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,269.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,248.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,248.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,248.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,372.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,248.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,248.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,372.6,
TRT THUMB FX,14800322,CDM,450,RC,,,outpatient,,,408.25,204.13,,396,97,,,percent of total billed charges,Pays at 97% of total billed charges,244.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,409.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,367.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,367.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,244.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,278.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,244.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,329.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,329.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,361.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,270.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,330.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,375.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,387.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,396,97,,,percent of total billed charges,Pays at 97% of total billed charges,265.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,244.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,244.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,244.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,367.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,244.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,244.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,367.43,
TRT UL FX,14800324,CDM,450,RC,,,outpatient,,,364.5,182.25,,353.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,328.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,328.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,265.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,248.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,294.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,294.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,322.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,241.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,295.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,335.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,346.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,353.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,236.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,328.05,
LY CLD SCALP 12.6-20.0,14800328,CDM,450,RC,,,outpatient,,,479.25,239.63,,464.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,287.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,357.65,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,431.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,431.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,287.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,348.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,327.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,287.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,386.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,386.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,424.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,317.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,388.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,440.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,455.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,464.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,311.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,287.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,431.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,287.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,287.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,431.33,
DEBRIDEMENT MUSCLE FASCIA FIRST 20SQ CM,14800332,CDM,450,RC,,,outpatient,,,364.5,182.25,,353.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,328.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,328.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,265.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,248.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,294.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,294.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,322.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,241.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,295.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,335.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,346.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,353.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,236.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,328.05,
RPR EXTENSOR TENDON,14800338,CDM,450,RC,,,outpatient,,,873.25,436.63,,847.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,523.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,526.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,785.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,785.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,523.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,635.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,595.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,523.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,704.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,704.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,773.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,578.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,707.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,803.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,829.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,847.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,567.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,523.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,523.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,523.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,785.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,523.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,523.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,785.93,
AMPUTATION DIGIT 1 OR 2,14800340,CDM,450,RC,,,outpatient,,,865.5,432.75,,839.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,519.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,605.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,778.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,778.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,519.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,629.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,590.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,519.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,698.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,698.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,766.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,573.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,701.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,796.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,822.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,839.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,562.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,519.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,519.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,519.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,778.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,519.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,519.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,778.95,
UPPER ENDOSCOPY W FB,14800342,CDM,450,RC,,,outpatient,,,509.5,254.75,,494.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,332.32,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,458.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,458.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,347.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,411.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,411.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,451.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,337.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,412.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,468.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,484.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,494.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,331.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,458.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,458.55,
INTRO OF NEELE VEIN,14800343,CDM,450,RC,,,outpatient,,,64.75,32.38,,62.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,52.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,59.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,62.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.85,102.86,
TUBE THORACOSTOMY RT,14800344,CDM,450,RC,,,outpatient,,,437,218.5,,423.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,393.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,393.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,317.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,298.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,352.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,352.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,387.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,289.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,353.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,402.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,415.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,423.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,284.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,393.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,393.3,
TUBE THORACOSTOMY LT,14800345,CDM,450,RC,,,outpatient,,,437,218.5,,423.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,393.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,393.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,317.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,298.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,352.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,352.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,387.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,289.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,353.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,402.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,415.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,423.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,284.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,393.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,393.3,
TUBE THORACOSTOMY BILATERAL,14800346,CDM,450,RC,,,outpatient,,,873.25,436.63,,847.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,523.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,785.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,785.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,523.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,635.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,595.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,523.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,704.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,704.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,773.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,578.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,707.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,803.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,829.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,847.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,567.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,523.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,523.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,523.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,785.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,523.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,523.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,785.93,
ET JANSSEN COVID 19 VAC ADMIN BOOSTER,14800349,CDM,771,RC,,,outpatient,,,88.25,44.13,,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,81.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,90,
TRT FX UL,14800352,CDM,450,RC,,,outpatient,,,335.75,167.88,,325.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,302.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,302.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,244.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,229.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,271.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,297.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,222.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,271.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,308.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,318.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,325.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,218.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,302.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,302.18,
SO/ORO GASTRIC TUBE,14800354,CDM,450,RC,,,outpatient,,,154,77,,149.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,92.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,138.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,138.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,105.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,92.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,124.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,102.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,124.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,141.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,146.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,149.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,92.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,92.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,138.6,
EXCISION BEN LES .5,14800356,CDM,450,RC,,,outpatient,,,192,96,,186.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.75,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,131.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,154.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,170.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,127.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,155.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,176.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,182.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,186.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,124.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,115.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,172.8,
CLSP TRT CARPAL FX,14800358,CDM,450,RC,,,outpatient,,,364.5,182.25,,353.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,284.71,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,328.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,328.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,265.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,248.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,294.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,294.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,322.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,241.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,295.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,335.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,346.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,353.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,236.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,328.05,
CLSD TRT FIB,14800372,CDM,450,RC,,,outpatient,,,328,164,,318.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,285.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,295.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,295.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,223.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,264.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,264.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,290.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,217.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,265.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,301.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,311.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,318.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,295.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,295.2,
Injection of medication into a tendon or ligament,14800374,CDM,450,RC,,,outpatient,,,145,72.5,,140.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,87,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,87,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,87,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,117.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,96.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,133.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,87,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,87,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,87,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.5,
CAST APP /HAND,14800376,CDM,450,RC,,,outpatient,,,71.25,35.63,,69.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.29,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,64.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,57.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,65.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,67.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,42.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.75,102.86,
CLSD TRT HUMERAL FX,14800378,CDM,450,RC,,,outpatient,,,437,218.5,,423.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,357.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,393.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,393.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,317.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,298.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,352.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,352.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,387.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,289.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,353.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,402.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,415.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,423.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,284.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,393.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,393.3,
CLSD TRT RADIAL FX H/N,14800380,CDM,450,RC,,,outpatient,,,303.75,151.88,,294.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,273.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,273.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,207.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,245.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,245.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,269.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,201.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,246.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,279.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,288.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,294.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,197.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,273.38,
TREAT TOE FX,14800382,CDM,450,RC,,,outpatient,,,242,121,,234.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,145.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.71,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,217.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,217.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,145.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,165.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,145.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,195.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,214.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,160.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,196.02,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,222.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,229.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,234.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,157.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,145.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,217.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,145.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,145.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,217.8,
TRT FX RADIUS & UL,14800384,CDM,450,RC,,,outpatient,,,694.25,347.13,,673.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,416.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,490.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,624.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,624.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,416.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,505.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,473.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,416.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,560.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,560.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,615.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,460.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,562.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,638.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,659.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,673.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,451.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,416.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,416.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,416.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,624.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,416.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,416.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,624.83,
TRT KNEE FX,14800386,CDM,450,RC,,,outpatient,,,364.5,182.25,,353.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,282.19,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,328.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,328.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,265.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,248.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,294.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,294.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,322.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,241.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,295.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,335.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,346.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,353.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,236.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,218.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,328.05,
INSERT PICC W/O PORT OR PUMP,14800388,CDM,450,RC,,,outpatient,,,1280.75,640.38,,1242.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1152.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1152.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,931.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,874.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1033.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1033.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1134.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,849.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1037.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1178.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,1216.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,1242.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,832.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1152.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,768.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1152.68,
"Removal of skin tags, multiple fibrocutaneous tags, any area",14800390,CDM,450,RC,,,outpatient,,,161,80.5,,156.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.66,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,144.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,144.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,109.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,129.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,106.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,130.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,148.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,152.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,156.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,96.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,144.9,
Fine Needle Aspiration Biopsy without imaging,14800392,CDM,450,RC,,,outpatient,,,303.75,151.88,,294.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.52,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,273.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,273.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,207.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,245.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,245.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,269.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,201.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,246.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,279.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,288.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,294.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,197.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,182.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,273.38,
CARDIOVERSION /EXT,14800400,CDM,450,RC,,,outpatient,,,1080,540,,1047.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,648,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.78,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,972,90,,,percent of total billed charges,Pays at 90% of total billed charges,972,90,,,percent of total billed charges,Pays at 90% of total billed charges,648,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,785.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,737.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,648,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,871.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,871.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,956.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,716.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,874.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,993.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,1026,95,,,percent of total billed charges,Pays at 95% of total billed charges,1047.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,702,65,,,percent of total billed charges,Pays at 65% of total billed charges,648,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,648,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,648,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,972,90,,,percent of total billed charges,Pays at 90% of total billed charges,648,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,648,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,972,
DRAIN PILONIDAL CYST,14800406,CDM,450,RC,,,outpatient,,,284.75,142.38,,276.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,170.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.1,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,256.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,256.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,170.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.18,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,194.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,170.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,229.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,229.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,252.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,188.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,230.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,261.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,270.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,276.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,185.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,170.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,256.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,170.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,170.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,256.28,
RMV EYELID FOR BODY,14800410,CDM,450,RC,,,outpatient,,,234,117,,226.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,225.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,210.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,210.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,159.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,140.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,207.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,155.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,189.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,215.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,222.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,226.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,152.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,140.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,140.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,140.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,210.6,
TRT FINGER FX /EA,14800412,CDM,450,RC,,,outpatient,,,583.25,291.63,,565.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,349.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,481.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,524.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,524.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,349.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,424.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,398.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,349.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,470.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,470.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,516.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,386.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,472.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,536.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,554.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,565.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,379.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,349.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,349.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,349.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,524.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,349.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,349.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,524.93,
LAYER CLOSE WOUND,14800414,CDM,450,RC,,,outpatient,,,411.25,205.63,,398.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,246.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,370.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,370.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,246.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,280.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,246.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,331.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,331.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,364.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,272.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,333.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,378.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,390.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,398.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,267.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,246.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,246.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,246.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,246.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,246.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,370.13,
TRT ELBOW DISLOCATION,14800416,CDM,450,RC,,,outpatient,,,206,103,,199.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,123.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,185.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,185.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,140.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,123.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,166.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,136.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,166.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,189.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,195.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,199.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,133.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,123.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,123.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,185.4,
TRT HUMERUS FRACTURE,14800417,CDM,450,RC,,,outpatient,,,363.25,181.63,,352.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,217.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,527.19,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,326.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,326.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,217.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,264.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,247.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,217.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,293.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,293.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,321.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,240.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,294.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,334.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,345.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,352.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,236.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,217.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,217.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,217.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,326.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,217.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,217.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,326.93,
TRT LOWER LEG FX,14800418,CDM,450,RC,,,outpatient,,,403.5,201.75,,391.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,242.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,298.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,363.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,363.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,242.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,293.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,275.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,242.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,325.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,325.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,357.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,267.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,326.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,371.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,383.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,391.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,262.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,242.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,363.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,242.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,242.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,363.15,
RMV FOR B /COMPLICATED,14800420,CDM,450,RC,,,outpatient,,,536.5,268.25,,520.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,321.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,255.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,482.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,482.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,321.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,390.36,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,366.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,321.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,433.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,433.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,475.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,355.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,434.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,493.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,509.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,520.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,348.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,321.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,321.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,321.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,482.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,321.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,321.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,482.85,
TRT WRIST BONE FX,14800422,CDM,450,RC,,,outpatient,,,335.75,167.88,,325.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,302.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,302.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,302.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,244.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,229.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,271.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,297.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,222.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,271.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,308.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,318.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,325.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,218.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,302.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,201.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,302.18,
TRT HEEL FX,14800428,CDM,450,RC,,,outpatient,,,327,163.5,,317.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,196.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,231.69,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,294.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,294.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,237.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,223.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,196.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,263.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,263.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,289.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,216.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,264.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,300.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,310.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,317.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,212.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,196.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,294.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,196.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,294.3,
DRAIN EYELID ABCESS,14800430,CDM,450,RC,,,outpatient,,,468,234,,453.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,280.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,245.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,421.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,421.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,280.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,340.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,319.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,280.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,377.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,377.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,414.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,310.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,379.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,430.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,444.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,453.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,304.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,280.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,280.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,280.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,280.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,280.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,421.2,
ER LEFT AFTER SCREEN,14800432,CDM,450,RC,,,outpatient,,,139.5,69.75,,135.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,123.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,113,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,128.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,132.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,135.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,90.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,83.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,125.55,
NERVE BLOCK OTHER,14800436,CDM,450,RC,,,outpatient,,,347,173.5,,336.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,208.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.16,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,312.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,312.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,208.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,236.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,208.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,280.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,280.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,307.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,230.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,281.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,319.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,329.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,336.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,225.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,208.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,312.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,208.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,208.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,312.3,
IRRIGATE BLADDER,14800438,CDM,450,RC,,,outpatient,,,321.25,160.63,,311.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.13,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,289.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,289.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,233.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,219.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,259.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,284.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,212.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,260.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,295.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,305.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,311.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,208.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,289.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,192.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,289.13,
TRT RADIUS FX,14800440,CDM,450,RC,,,outpatient,,,437,218.5,,423.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,419.08,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,393.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,393.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,317.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,298.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,352.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,352.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,387.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,289.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,353.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,402.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,415.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,423.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,284.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,393.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,262.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,393.3,
APPLY L ARM SPLINT,14800442,CDM,450,RC,,,outpatient,,,201.25,100.63,,195.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,120.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,181.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,181.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,137.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,120.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,162.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,178.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,133.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,163.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,185.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,191.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,195.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,130.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,120.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,120.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,181.13,
INCISE EXT HEMORRHOID,14800444,CDM,450,RC,,,outpatient,,,401.5,200.75,,389.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,240.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,361.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,361.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,240.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,292.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,274.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,240.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,324.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,324.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,355.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,266.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,325.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,369.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,381.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,389.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,260.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,240.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,240.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,240.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,361.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,240.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,240.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,361.35,
RPR SUPERFICIAL WOUND 20.1CM TO 30.0CM,14800448,CDM,450,RC,,,outpatient,,,385,192.5,,373.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,231,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,346.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,346.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,231,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,280.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,262.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,231,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,310.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,310.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,341.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,255.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,311.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,354.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,365.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,373.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,250.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,231,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,231,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,231,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,346.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,231,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,231,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,346.5,
STRAP SHOULDER,14800450,CDM,450,RC,,,outpatient,,,282.75,141.38,,274.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,169.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,254.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,254.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,169.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,192.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,169.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,228.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,250.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,187.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,229.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,260.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,268.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,274.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,183.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,169.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,169.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,254.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,169.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,169.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,254.48,
RPR TONGUE LACERATION,14800454,CDM,450,RC,,,outpatient,,,386,193,,374.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,231.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,298.57,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,347.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,347.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,231.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,280.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,263.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,231.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,311.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,311.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,342.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,255.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,312.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,355.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,366.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,374.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,250.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,231.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,231.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,231.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,347.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,231.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,231.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,347.4,
RESET DISLOCATED JAW,14800458,CDM,450,RC,,,outpatient,,,341.75,170.88,,331.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,205.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,307.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,307.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,205.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,248.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,233.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,205.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,275.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,275.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,302.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,226.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,276.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,314.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,324.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,331.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,222.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,205.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,307.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,205.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,205.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,307.58,
TRT KNEECAP DISLOCATION,14800460,CDM,450,RC,,,outpatient,,,346.75,173.38,,336.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,208.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,348.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,312.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,312.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,208.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,236.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,208.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,279.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,279.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,307.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,229.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,280.87,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,319.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,329.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,336.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,225.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,208.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,312.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,208.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,208.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,312.08,
I & D VULVA/PERINEUM,14800462,CDM,450,RC,,,outpatient,,,388,194,,376.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,232.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,349.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,349.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,282.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,264.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,232.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,313.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,343.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,257.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,314.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,356.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,368.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,376.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,252.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,232.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,349.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,232.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,232.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,349.2,
REMOVE/REVISE CAST,14800464,CDM,450,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.69,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
I & D /BURSA,14800466,CDM,450,RC,,,outpatient,,,512,256,,496.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,307.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,460.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,460.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,307.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,372.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,349.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,307.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,413.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,413.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,453.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,339.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,414.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,471.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,486.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,496.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,332.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,307.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,307.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,307.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,460.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,307.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,307.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,460.8,
CATH FOR SPECIMEN COLL,14800468,CDM,300,RC,,,outpatient,,,95.25,47.63,,92.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,85.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,69.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,65.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,76.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,63.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,87.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,90.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,92.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,85.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,,,,,Other,Not Separately reimbursable,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.57,100,
TRT FINGER FX,14800470,CDM,450,RC,,,outpatient,,,291.5,145.75,,282.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,318.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,198.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,235.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,258.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,193.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,236.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,268.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,276.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,282.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,189.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,262.35,
PORT FLUSH ONLY,14800472,CDM,450,RC,,,outpatient,,,92.5,46.25,,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,74.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,102.86,
INCISE WINDPIPE,14800480,CDM,450,RC,,,outpatient,,,259.5,129.75,,251.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,341.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,233.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,233.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,177.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,209.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,229.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,172.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,210.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,238.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,246.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,251.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,233.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,155.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,233.55,
INSERT NON-TUNNEL CV,14800482,CDM,450,RC,,,outpatient,,,518.5,259.25,,502.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,466.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,466.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,377.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,353.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,418.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,418.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,459.44,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,343.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,419.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,477.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,492.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,502.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,337.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,466.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,311.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,466.65,
RPR WOUND/LESION,14800484,CDM,450,RC,,,outpatient,,,693.25,346.63,,672.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,415.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,448.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,623.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,623.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,415.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,504.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,473.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,415.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,559.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,559.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,614.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,459.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,561.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,637.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,658.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,672.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,450.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,415.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,415.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,415.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,623.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,415.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,415.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,623.93,
DRAIN SKIN ABSCESS,14800486,CDM,450,RC,,,outpatient,,,328,164,,318.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,295.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,295.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,223.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,264.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,264.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,290.64,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,217.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,265.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,301.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,311.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,318.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,213.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,295.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,196.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,295.2,
RMV HEMORRHOID CLOT,14800488,CDM,450,RC,,,outpatient,,,377.5,188.75,,366.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,226.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,339.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,339.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,226.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,274.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,257.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,226.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,304.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,304.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,334.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,250.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,305.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,347.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,358.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,366.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,245.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,226.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,339.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,226.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,226.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,339.75,
INCISE AL ABSCESS,14800492,CDM,450,RC,,,outpatient,,,369,184.5,,357.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.83,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,332.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,332.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,268.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,251.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,297.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,326.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,244.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,298.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,339.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,350.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,357.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,239.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,332.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,221.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,332.1,
LAYER CLOSE WOUND,14800494,CDM,450,RC,,,outpatient,,,375.5,187.75,,364.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,225.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,325.98,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,337.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,337.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,225.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,256.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,225.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,303.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,303.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,332.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,248.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,304.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,345.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,356.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,364.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,244.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,225.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,225.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,225.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,337.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,225.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,225.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,337.95,
RPR WOUND OR LESION,14800498,CDM,450,RC,,,outpatient,,,690.5,345.25,,669.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,414.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,477.65,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,621.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,621.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,414.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,502.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,471.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,414.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,557.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,557.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,611.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,457.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,559.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,635.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,655.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,669.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,448.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,414.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,414.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,414.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,621.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,414.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,414.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,621.45,
DRAIN EXT EAR LESION,14800504,CDM,450,RC,,,outpatient,,,291.5,145.75,,282.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.64,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,198.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,235.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,258.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,193.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,236.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,268.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,276.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,282.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,189.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,262.35,
INCISE RECTAL ABSCESS,14800506,CDM,450,RC,,,outpatient,,,509.5,254.75,,494.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,513.64,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,458.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,458.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,370.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,347.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,411.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,411.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,451.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,337.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,412.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,468.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,484.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,494.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,331.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,458.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,305.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,458.55,
CLSD TRT CARPAL BONE FX,14800508,CDM,450,RC,,,outpatient,,,354.25,177.13,,343.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,212.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,434.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,318.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,318.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,212.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,257.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,241.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,212.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,285.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,285.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,313.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,234.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,286.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,325.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,336.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,343.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,230.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,212.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,318.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,212.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,212.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,318.83,
LARYNGSCOPY FOR ASPIRATION,14800510,CDM,450,RC,,,outpatient,,,291.5,145.75,,282.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,187.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,198.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,235.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,258.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,193.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,236.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,268.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,276.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,282.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,189.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,262.35,
"TRT CLSD ELBOW DISLOCATION, NO ANESTH",14800512,CDM,450,RC,,,outpatient,,,291.5,145.75,,282.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,352.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,198.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,235.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,258.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,193.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,236.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,268.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,276.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,282.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,189.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,262.35,
CLOSED TX BIMALLEOLAR FX MAN,14800514,CDM,450,RC,,,outpatient,,,358.25,179.13,,347.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,214.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,446.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,322.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,322.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,214.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,260.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,244.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,214.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,289.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,289.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,317.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,237.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,290.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,329.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,340.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,347.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,232.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,214.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,214.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,214.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,322.43,
DECLOTTING THROMB,14800520,CDM,450,RC,,,outpatient,,,544.75,272.38,,528.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,326.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.25,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,490.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,490.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,326.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,396.36,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,371.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,326.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,439.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,439.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,482.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,361.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,441.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,501.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,517.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,528.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,354.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,326.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,326.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,326.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,490.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,326.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,326.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,490.28,
PLC NEEDLE INTRAOSSEOUS,14800521,CDM,450,RC,,,outpatient,,,120.5,60.25,,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,72.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.45,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-same drug add on",14800522,CDM,450,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,102.86,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-same drug add on",14800524,CDM,761,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,102.86,
DRAIGE ABSCESS DENTOALVEOLAR STRUCTURE,14800528,CDM,450,RC,,,outpatient,,,278.25,139.13,,269.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,166.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.97,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,250.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,189.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,166.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,224.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,246.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,184.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,225.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,255.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,264.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,269.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,180.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,166.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,166.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,250.43,
ET PEDS PFIZER COVID19 VAC ADMIN 1ST DOS,14800719,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
ET PEDS PFIZER COVID19 VAC ADMIN 2ND DOS,14800729,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
EO SAL HEMOR /ANTER SIMPLE,14800901,CDM,761,RC,,,outpatient,,,176,88,,170.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.23,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,116.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,142.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,161.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,170.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,158.4,
Immunization administration by a medical assistant or nurse,14801004,CDM,771,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,102.86,
IV INF/HYD INIT 31-60 MIN,14801028,CDM,450,RC,,,outpatient,,,274.75,137.38,,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.28,
IV HYD EACH ADDTL HR,14801030,CDM,450,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
IV INF/HYD INIT 31-60 MIN,14801031,CDM,761,RC,,,outpatient,,,274.75,137.38,,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.28,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",14801032,CDM,450,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",14801034,CDM,450,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
ADDTL SEQUENT INF UP-1HR,14801036,CDM,450,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
CONCURRENT INFUSION,14801038,CDM,450,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
THER INJ SQ OR IM,14801040,CDM,450,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
THER INJ INTRA-ARTERIAL,14801042,CDM,450,RC,,,outpatient,,,50.75,25.38,,49.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,41.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,46.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,48.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,49.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",14801044,CDM,450,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",14801046,CDM,450,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
IV INF/HYD INIT 31-60 MIN MOD XE,14801800,CDM,450,RC,,,outpatient,,,274.75,137.38,,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.28,
IV HYD EACH ADDTL HR MOD XE,14801801,CDM,450,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",14801802,CDM,450,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",14801803,CDM,450,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
ADDTL SEQUENT INF UP-1HR MOD XE,14801804,CDM,450,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
CONCURRENT INFUSION MOD XE,14801805,CDM,450,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
THER INJ SQ OR IM MOD XE,14801806,CDM,450,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",14801807,CDM,450,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",14801808,CDM,450,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-same drug add on",14801809,CDM,450,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,102.86,
IV INF/HYD INIT 31-60 MIN MOD XS,14801810,CDM,450,RC,,,outpatient,,,274.75,137.38,,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.28,
IV HYD EACH ADDTL HR MOD XS,14801811,CDM,450,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",14801812,CDM,450,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",14801813,CDM,450,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
ADDTL SEQUENT INF UP-1HR MOD XS,14801814,CDM,450,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
CONCURRENT INFUSION MOD XS,14801815,CDM,450,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
THER INJ SQ OR IM MOD XS,14801816,CDM,450,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",14801817,CDM,450,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",14801818,CDM,450,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-same drug add on",14801819,CDM,450,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,102.86,
IV INF/HYD INIT 31-60 MIN MOD XU,14801820,CDM,450,RC,,,outpatient,,,274.75,137.38,,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.28,
IV HYD EACH ADDTL HR MOD XU,14801821,CDM,450,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",14801822,CDM,450,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",14801823,CDM,450,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
ADDTL SEQUENT INF UP-1HR MOD XU,14801824,CDM,450,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
CONCURRENT INFUSION MOD XU,14801825,CDM,450,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
THER INJ SQ OR IM MOD XU,14801826,CDM,450,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",14801827,CDM,450,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",14801828,CDM,450,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-same drug add on",14801829,CDM,450,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,102.86,
IV INF/HYD INIT 31-60 MIN MOD XP,14801830,CDM,450,RC,,,outpatient,,,274.75,137.38,,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.28,
IV HYD EACH ADDTL HR MOD XP,14801831,CDM,450,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",14801832,CDM,450,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",14801833,CDM,450,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
ADDTL SEQUENT INF UP-1HR MOD XP,14801834,CDM,450,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
CONCURRENT INFUSION MOD XP,14801835,CDM,450,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
THER INJ SQ OR IM MOD XP,14801836,CDM,450,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",14801837,CDM,450,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",14801838,CDM,450,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-same drug add on",14801839,CDM,450,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,102.86,
IV INF/HYD INIT 31-60 MIN MOD XE,14801900,CDM,450,RC,,,outpatient,,,274.75,137.38,,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.28,
IV HYD EACH ADDTL HR MOD XE,14801901,CDM,450,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",14801902,CDM,450,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",14801903,CDM,450,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
ADDTL SEQUENT INF UP-1HR MOD XE,14801904,CDM,450,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
CONCURRENT INFUSION MOD XE,14801905,CDM,450,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
THER INJ SQ OR IM MOD XE,14801906,CDM,450,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",14801907,CDM,450,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",14801908,CDM,450,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-same drug add on",14801909,CDM,450,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,102.86,
IV INF/HYD INIT 31-60 MIN MOD XS,14801910,CDM,450,RC,,,outpatient,,,274.75,137.38,,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.28,
IV HYD EACH ADDTL HR MOD XS,14801911,CDM,450,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",14801912,CDM,450,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",14801913,CDM,450,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
ADDTL SEQUENT INF UP-1HR MOD XS,14801914,CDM,450,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
CONCURRENT INFUSION MOD XS,14801915,CDM,450,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
THER INJ SQ OR IM MOD XS,14801916,CDM,450,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",14801917,CDM,450,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",14801918,CDM,450,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-same drug add on",14801919,CDM,450,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,102.86,
IV INF/HYD INIT 31-60 MIN MOD XU,14801920,CDM,450,RC,,,outpatient,,,274.75,137.38,,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.28,
IV HYD EACH ADDTL HR MOD XU,14801921,CDM,450,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",14801922,CDM,450,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",14801923,CDM,450,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
ADDTL SEQUENT INF UP-1HR MOD XU,14801924,CDM,450,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
CONCURRENT INFUSION MOD XU,14801925,CDM,450,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
THER INJ SQ OR IM MOD XU,14801926,CDM,450,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",14801927,CDM,450,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",14801928,CDM,450,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-same drug add on",14801929,CDM,450,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,102.86,
IV INF/HYD INIT 31-60 MIN MOD XP,14801930,CDM,450,RC,,,outpatient,,,274.75,137.38,,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.28,
IV HYD EACH ADDTL HR MOD XP,14801931,CDM,450,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",14801932,CDM,450,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",14801933,CDM,450,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
ADDTL SEQUENT INF UP-1HR MOD XP,14801934,CDM,450,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
CONCURRENT INFUSION MOD XP,14801935,CDM,450,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
THER INJ SQ OR IM MOD XP,14801936,CDM,450,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",14801937,CDM,450,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",14801938,CDM,450,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-same drug add on",14801939,CDM,450,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,102.86,
IV INF/HYD INIT 31-60 MIN,14802028,CDM,450,RC,,,outpatient,,,274.75,137.38,,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.28,
IV HYD EACH ADDTL HR,14802030,CDM,450,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
IV INF/HYD INIT 31-60 MIN,14802031,CDM,450,RC,,,outpatient,,,274.75,137.38,,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.28,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",14802032,CDM,450,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",14802034,CDM,450,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
ADDTL SEQUENT INF UP-1HR,14802036,CDM,450,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
CONCURRENT INFUSION,14802038,CDM,450,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
THER INJ SQ OR IM,14802040,CDM,450,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
THER INJ INTRA-ARTERIAL,14802042,CDM,450,RC,,,outpatient,,,50.75,25.38,,49.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,41.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,46.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,48.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,49.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",14802044,CDM,450,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",14802046,CDM,761,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"INJ TRIGGER POINT, 1/2 MUSCLE",14802052,CDM,450,RC,,,outpatient,,,100,50,,97,97,,,percent of total billed charges,Pays at 97% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.94,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,90,90,,,percent of total billed charges,Pays at 90% of total billed charges,90,90,,,percent of total billed charges,Pays at 90% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,68.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,66.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,92,92,,,percent of total billed charges,Pays at 92% of total billed charges,95,95,,,percent of total billed charges,Pays at 95% of total billed charges,97,97,,,percent of total billed charges,Pays at 97% of total billed charges,65,65,,,percent of total billed charges,Pays at 65% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90,90,,,percent of total billed charges,Pays at 90% of total billed charges,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,60,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
LAY WOUND 12.6 - 20.0,14802054,CDM,450,RC,,,outpatient,,,514.5,257.25,,499.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,308.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,444.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,463.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,463.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,308.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,374.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,351.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,308.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,415.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,415.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,455.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,341.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,416.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,473.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,488.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,499.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,334.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,308.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,463.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,308.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,308.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,463.05,
CONTROL NOSEBLEED,14802056,CDM,450,RC,,,outpatient,,,262.5,131.25,,254.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,157.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,236.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,236.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,191,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,179.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,157.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,211.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,211.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,232.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,174.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,212.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,241.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,249.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,254.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,170.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,157.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,236.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,157.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,236.25,
REPEAT CONTROL NOSEBLEED,14802058,CDM,450,RC,,,outpatient,,,291.5,145.75,,282.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,314.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,198.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,235.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,258.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,193.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,236.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,268.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,276.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,282.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,189.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,262.35,
SIALOLITHOTOMY,14802068,CDM,450,RC,,,outpatient,,,248.75,124.38,,241.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,149.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,217.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,223.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,223.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,169.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,149.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,200.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,220.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,164.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,201.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,228.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,236.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,241.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,161.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,149.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,149.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,223.88,
LAYER CLOSE WOUND,14802070,CDM,450,RC,,,outpatient,,,763,381.5,,740.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,457.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,338.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,686.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,686.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,457.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,555.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,520.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,457.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,615.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,615.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,676.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,505.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,618.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,701.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,724.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,740.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,495.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,457.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,457.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,457.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,686.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,457.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,457.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,686.7,
TRT HIP DISLOCATION,14802076,CDM,450,RC,,,outpatient,,,485.25,242.63,,470.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,291.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.77,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,436.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,436.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,291.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,353.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,331.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,291.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,391.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,391.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,429.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,321.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,393.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,446.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,460.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,470.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,315.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,291.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,291.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,291.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,436.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,291.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,291.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,436.73,
THORACENTESIS  NDLE OR CATH ASP W/O IM R,14802255,CDM,450,RC,,,outpatient,,,1623.25,811.63,,1574.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1460.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1460.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1181.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1107.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1310.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1310.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1438.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1076.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1314.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1493.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,1542.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,1574.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,1055.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1460.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1460.93,
TELEHEALTH STROKE ORIGITE SITE FAC FEE,14803014,CDM,780,RC,,,outpatient,,,69,34.5,,66.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,62.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,45.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,55.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,63.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,65.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,66.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,41.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.4,90,
TRAUMA TEAM ACTIVATION,14803900,CDM,684,RC,,,outpatient,,,1634.5,817.25,,1585.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,980.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,444.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1471.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1471.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,980.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1189.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1115.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,980.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1319.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1319.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1448.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1083.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1323.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1503.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,1552.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,1585.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,1062.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,980.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,980.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,980.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1471.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,980.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,980.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1471.05,
TRAUMA TEAM ACTIVATION CRIT CARE < 30 M,14803901,CDM,684,RC,,,outpatient,,,1634.5,817.25,,1585.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,980.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,490.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,1471.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1471.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,980.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1189.26,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1115.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,980.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1319.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1319.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1448.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1083.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1323.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1503.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,1552.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,1585.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,1062.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,980.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,980.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,980.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1471.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,980.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,980.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1471.05,
REMOVAL FB EXTERL EYE CORNEAL SLIT LAM,14805222,CDM,450,RC,,,outpatient,,,37.75,18.88,,36.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,33.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,34.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,36.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.65,102.86,
IV INF/HYD INIT 31-60 MIN MOD 59,14806360,CDM,450,RC,,,outpatient,,,274.75,137.38,,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.28,
IV HYD EACH ADDTL HR MOD 59,14806361,CDM,450,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",14806365,CDM,450,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",14806366,CDM,450,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
ADDTL SEQUENT INF UP-1HR MOD 59,14806367,CDM,450,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
CONCURRENT INFUSION MOD 59,14806368,CDM,450,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
THER INJ SQ OR IM MOD 59,14806372,CDM,450,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
THER INJ INTRA-ARTERIAL MOD 59,14806373,CDM,450,RC,,,outpatient,,,50.75,25.38,,49.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,41.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,46.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,48.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,49.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",14806374,CDM,450,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",14806375,CDM,450,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-same drug add on",14806376,CDM,450,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,102.86,
DRUG ADMIN SQ OR IM MOD 59,14806401,CDM,450,RC,,,outpatient,,,235.75,117.88,,228.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.64,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,212.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,212.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,160.9,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,190.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,208.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,156.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,190.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,216.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,223.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,228.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,153.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,141.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,212.18,
DRUG ADMIN IV UP TO 1 HOUR MOD 59,14806413,CDM,450,RC,,,outpatient,,,587,293.5,,569.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,352.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,528.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,528.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,352.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,427.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,400.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,352.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,473.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,473.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,520.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,389.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,475.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,540.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,557.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,569.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,381.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,352.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,352.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,352.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,528.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,352.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,352.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,528.3,
Chemotherapy infusion-each additiol hour,14806415,CDM,450,RC,,,outpatient,,,182.75,91.38,,177.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,124.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,161.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,121.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,148.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,168.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,173.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,177.27,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,109.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,164.48,
PORT FLUSH ONLY MOD 59,14806523,CDM,450,RC,,,outpatient,,,92.5,46.25,,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,74.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,102.86,
REMOVAL IMPACTED CERUM IRRG/LAV,14809209,CDM,450,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,102.86,
INC & DRAIN PILONIDAL CYST COMPLICATED,14810081,CDM,450,RC,,,outpatient,,,215.5,107.75,,209.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,129.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,255.2,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,193.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,193.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,129.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,147.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,129.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,173.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,190.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,142.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,174.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,198.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,204.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,209.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,129.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,129.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,129.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,193.95,
I&D COMPLEX POST OP WOUND INFECT,14810180,CDM,450,RC,,,outpatient,,,60.75,30.38,,58.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,234.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,54.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,41.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,36.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,53.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,40.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,49.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,55.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,57.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,58.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,36.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,36.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.45,102.86,
DEBRIDEMENT OPEN FX SUBQ MUSCLE & BONE,14811012,CDM,450,RC,,,outpatient,,,2261.5,1130.75,,2193.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,1356.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,654.32,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2035.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,2035.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,1356.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1645.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1543.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1356.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1825.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1825.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2003.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1499.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1831.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2080.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,2148.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,2193.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,1469.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,1356.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1356.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1356.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2035.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,1356.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1356.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2035.35,
DEBRIDEMENT SUBSEQ BONE,14811044,CDM,450,RC,,,outpatient,,,1383.75,691.88,,1342.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,830.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,300.77,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1245.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,1245.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,830.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1006.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,944.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,830.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1116.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1116.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1226.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,917.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1120.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1273.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,1314.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,1342.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,899.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,830.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,830.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,830.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1245.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,830.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,830.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1245.38,
TRT SHOULDER DISLOCATION,14811056,CDM,450,RC,,,outpatient,,,240.75,120.38,,233.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,301.48,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,216.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,216.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,175.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,164.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,194.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,213.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,159.62,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,195.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,221.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,228.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,233.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,156.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,216.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,144.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,216.68,
INCISIOL BX SKIN SINGLE LESION,14811106,CDM,450,RC,,,outpatient,,,277.75,138.88,,269.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,249.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,249.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,189.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,224.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,246.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,184.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,224.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,255.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,263.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,269.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,180.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,249.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,166.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,249.98,
TRT OF SUPERFICIAL WOUND DEHISCENCE W PA,14812021,CDM,450,RC,,,outpatient,,,515.25,257.63,,499.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,309.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,463.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,463.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,309.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,374.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,351.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,309.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,415.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,415.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,456.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,341.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,417.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,474.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,489.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,499.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,334.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,309.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,309.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,309.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,463.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,309.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,309.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,463.73,
RPR INTERM WND NECK HAND FEET 12.6-20.0,14812045,CDM,450,RC,,,outpatient,,,214.25,107.13,,207.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,128.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,374.65,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,192.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,192.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,146.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,128.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,172.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,189.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,142.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,173.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,197.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,203.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,207.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,139.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,128.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,128.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,192.83,
COMPLEX REPAIR SCALP/ARMS/LEGS,14813121,CDM,450,RC,,,outpatient,,,327.25,163.63,,317.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,196.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,261.5,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,294.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,294.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,238.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,223.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,196.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,264.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,264.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,289.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,216.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,265.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,301.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,310.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,317.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,212.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,196.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,294.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,196.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,196.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,294.53,
COMPLEX REPAIR SCALP/ARMS/LEGS EA ADD,14813122,CDM,450,RC,,,outpatient,,,90.25,45.13,,87.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,73.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,83.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,85.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,87.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,54.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.15,102.86,
"REPAIR, COMPLEX, FOREHAD, 1.1 TO 2.5 CM",14813131,CDM,450,RC,,,outpatient,,,395.75,197.88,,383.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,237.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,363.04,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,356.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,356.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,237.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,287.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,270.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,237.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,319.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,319.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,350.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,262.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,320.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,364.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,375.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,383.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,257.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,237.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,237.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,237.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,356.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,237.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,237.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,356.18,
RML FOR BODY MUS SIMP,14820520,CDM,450,RC,,,outpatient,,,550.75,275.38,,534.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,330.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,191.3,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,495.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,495.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,330.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,375.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,330.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,444.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,444.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,488.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,365.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,446.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,506.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,523.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,534.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,357.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,330.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,330.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,330.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,495.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,330.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,330.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,495.68,
Injection of medication into an area that triggers pain,14820553,CDM,450,RC,,,outpatient,,,41.75,20.88,,40.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,38.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,39.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.05,102.86,
CLSD TX CLAVICULAR FX W/O MANIP,14823500,CDM,450,RC,,,outpatient,,,438.75,219.38,,425.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,263.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,394.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,394.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,263.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,319.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,299.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,263.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,354.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,354.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,388.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,290.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,355.39,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,403.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,416.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,425.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,285.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,263.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,263.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,263.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,394.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,263.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,263.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,394.88,
HUMERAL NECK FRACTURE,14823600,CDM,450,RC,,,outpatient,,,592.5,296.25,,574.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,355.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,307.13,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,533.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,533.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,355.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,431.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,404.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,355.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,478.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,478.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,525.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,392.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,479.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,545.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,562.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,574.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,385.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,355.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,355.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,355.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,533.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,355.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,355.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,533.25,
TX SHOULDER DISLOCATION,14823665,CDM,450,RC,,,outpatient,,,926.75,463.38,,898.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,556.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,407.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,834.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,834.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,556.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,674.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,632.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,556.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,748.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,748.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,821.19,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,614.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,750.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,852.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,880.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,898.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,602.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,556.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,556.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,556.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,834.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,556.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,556.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,834.08,
CLSD TX DIST RADIOULR W/MANIP,14825675,CDM,450,RC,,,outpatient,,,77.5,38.75,,75.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,415.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,69.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,51.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,62.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,71.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,73.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,75.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.5,102.86,
DRAIGE FINGER ABCESS SIMPLE,14826010,CDM,450,RC,,,outpatient,,,291.5,145.75,,282.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,245.71,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,198.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,235.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,258.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,193.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,236.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,268.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,276.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,282.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,189.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,174.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,262.35,
CL TX DISTAL PHAL FX FINGER/THUMB W/MANI,14826755,CDM,450,RC,,,outpatient,,,95.5,47.75,,92.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,296.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,85.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,65.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,63.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,77.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,87.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,90.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,92.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.3,102.86,
ED CLOSED TX DISTAL FIB FX W/MANIP TECH,14827788,CDM,450,RC,,,outpatient,,,110.5,55.25,,107.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,402.08,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,99.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,66.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,75.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,66.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,73.26,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,89.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,101.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,104.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,107.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,66.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,66.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,66.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
ED CL TX FX DISTAL TIBIA W/SKELET TRACT,14827825,CDM,450,RC,,,outpatient,,,152.25,76.13,,147.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,528.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,137.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,137.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,103.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,122.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,100.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,123.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,140.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,144.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,147.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,98.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,91.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,137.03,
CLOSED TRT ANKLE DISLOC WO ANESTHESIA,14827840,CDM,450,RC,,,outpatient,,,178,89,,172.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,106.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,359.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,160.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,160.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.51,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,121.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,106.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,157.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,118.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,144.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,163.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,169.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,172.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,115.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,106.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,160.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,106.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,160.2,
CLOSED TX CALCANEAL FX WITH MANIP,14828405,CDM,450,RC,,,outpatient,,,70.75,35.38,,68.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,373.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,63.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,57.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,65.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,67.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,68.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,42.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.45,102.86,
TX TARSAL BONE FX W MANIP EA,14828455,CDM,450,RC,,,outpatient,,,413.75,206.88,,401.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,248.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,272.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,372.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,372.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,248.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,301.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,282.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,248.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,333.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,333.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,366.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,274.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,335.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,380.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,393.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,401.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,268.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,248.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,248.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,248.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,372.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,248.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,248.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,372.38,
"CL TX FX GREAT TOE, PHALANX OR PHALANGES",14828495,CDM,450,RC,,,outpatient,,,50.75,25.38,,49.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.55,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,41.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,46.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,48.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,49.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,102.86,
CL TX METATARSOPHAL JT DISLOCAT W/O ANES,14828630,CDM,450,RC,,,outpatient,,,81,40.5,,78.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,72.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,55.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,65.61,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,74.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,76.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,78.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,48.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,48.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.6,102.86,
CONTROL SAL BLEED ANTER SIMP BILAT,14830901,CDM,450,RC,,,outpatient,,,179.75,89.88,,174.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.23,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,161.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,161.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,122.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,145.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,159.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,119.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,145.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,165.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,170.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,174.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,116.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,107.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,161.78,
THORACENTESIS  NEEDLE OR CATH ASP W/O IM,14832554,CDM,450,RC,,,outpatient,,,1623.25,811.63,,1574.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1460.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,1460.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1181.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1107.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1310.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1310.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1438.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1076.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1314.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1493.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,1542.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,1574.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,1055.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1460.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,973.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1460.93,
"VENIPUNCTURE 3 YRS OR >, PHYS SKILL",14836410,CDM,450,RC,,,outpatient,,,20.25,10.13,,19.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,16.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,18.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,12.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.15,102.86,
INSERTION TUNNELED CENTRALLY INSERTED CE,14836558,CDM,450,RC,,,outpatient,,,1225,612.5,,1188.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,735,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,689.14,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1102.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,1102.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,735,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,891.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,836.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,735,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,988.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,988.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1085.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,812.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,992.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1127,92,,,percent of total billed charges,Pays at 92% of total billed charges,1163.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,1188.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,796.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,735,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,735,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,735,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1102.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,735,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,735,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1102.5,
INSERT TUNNELED CV CATH OUTSIDE SERVICE,14836569,CDM,450,RC,,,outpatient,,,1723,861.5,,1671.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1550.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1550.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1253.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1175.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1390.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1390.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1526.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1142.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1395.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1585.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,1636.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,1671.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,1119.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1550.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1550.7,
REMOVAL TUNNELED CENTRAL VEN CATH WO SUB,14836589,CDM,450,RC,,,outpatient,,,522.25,261.13,,506.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,313.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,470.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,470.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,379.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,356.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,313.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,421.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,462.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,346.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,423.02,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,480.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,496.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,506.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,339.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,313.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,470.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,313.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,470.03,
VENOUS ACCESS DEVICE COLL BLOOD,14836591,CDM,450,RC,,,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,21.04,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,102.86,100,,,Case rate,pays at 100% of fixed rate,,,,,Other,Not Separately reimbursable,100,102.86,
COLL BLOOD CENTRAL/PERIPHERAL CATH,14836592,CDM,450,RC,,,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,23.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,102.86,100,,,Case rate,pays at 100% of fixed rate,,,,,Other,Not Separately reimbursable,100,102.86,
ED REPAIR LIP FULL,14840650,CDM,450,RC,,,outpatient,,,354.75,177.38,,344.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,212.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.86,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,319.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,319.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,212.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,258.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,242.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,212.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,286.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,286.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,314.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,235.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,287.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,326.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,337.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,344.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,230.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,212.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,319.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,212.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,212.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,319.28,
REPAIR ORAL MUCOSA,14840830,CDM,450,RC,,,outpatient,,,225,112.5,,218.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,202.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,153.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,181.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,199.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,182.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,207,92,,,percent of total billed charges,Pays at 92% of total billed charges,213.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,218.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,135,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,202.5,
GASTRIC INTUBATIOSP THERAPEUTIC,14843753,CDM,450,RC,,,outpatient,,,32.5,16.25,,31.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,29.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,29.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,30.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,31.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,19.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.5,102.86,
REPLACEMENT GASTROSTOMY TUBE,14843762,CDM,450,RC,,,outpatient,,,533.25,266.63,,517.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,319.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.48,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,479.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,479.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,319.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,387.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,363.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,319.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,430.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,430.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,472.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,353.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,431.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,490.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,506.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,517.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,346.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,319.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,319.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,319.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,479.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,319.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,319.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,479.93,
REMOVAL FECAL IMPACTION/FB UNDER ANESTHE,14845915,CDM,450,RC,,,outpatient,,,148.25,74.13,,143.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,317.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,133.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,131.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,136.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,140.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,143.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,133.43,
DESTRUCTION LESION PENIS SIMPLE SURG EXC,14854060,CDM,450,RC,,,outpatient,,,94.25,47.13,,91.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.68,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,84.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,64.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,62.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,76.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,86.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,89.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,91.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.55,102.86,
INCISION AND DRAIN EPIDIYMIS,14854700,CDM,450,RC,,,outpatient,,,354,177,,343.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,212.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.64,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,318.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,318.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,212.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,257.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,241.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,212.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,285.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,285.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,313.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,234.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,286.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,325.68,92,,,percent of total billed charges,Pays at 92% of total billed charges,336.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,343.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,230.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,212.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,318.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,212.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,212.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,318.6,
DRAIGE OF SCROTUM ABCESS,14855100,CDM,450,RC,,,outpatient,,,952,476,,923.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,571.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,856.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,856.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,571.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,692.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,649.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,571.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,768.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,768.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,843.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,631.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,771.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,875.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,904.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,923.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,618.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,571.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,571.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,571.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,856.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,571.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,571.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,856.8,
INCISION & DRAIGE BARTHOLIN GLAND,14856420,CDM,450,RC,,,outpatient,,,157,78.5,,152.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.9,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,141.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,107.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,139.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,104.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,127.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,144.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,149.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,152.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,102.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,94.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,141.3,
VAGIL PACKING FOR HEMORRHAGE,14857180,CDM,450,RC,,,outpatient,,,180,90,,174.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.45,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,162,90,,,percent of total billed charges,Pays at 90% of total billed charges,162,90,,,percent of total billed charges,Pays at 90% of total billed charges,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,122.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,145.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,145.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,159.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,119.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,145.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,165.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,171,95,,,percent of total billed charges,Pays at 95% of total billed charges,174.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,117,65,,,percent of total billed charges,Pays at 65% of total billed charges,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,162,90,,,percent of total billed charges,Pays at 90% of total billed charges,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,108,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,162,
REMOVE IUD,14858301,CDM,450,RC,,,outpatient,,,148.25,74.13,,143.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,133.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,119.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,131.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,136.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,140.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,143.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,88.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,133.43,
Vagil delivery,14859409,CDM,450,RC,,,outpatient,,,2323.75,1161.88,,2254.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,1394.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,832.65,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2091.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2091.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,1394.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1690.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1585.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1394.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1875.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1875.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2059.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1540.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1882.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2137.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,2207.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,2254.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,1510.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,1394.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1394.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1394.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2091.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,1394.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1394.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2091.38,
SPIL TAP THERAPEUTIC DRAIN SPIL FLUI,14862272,CDM,450,RC,,,outpatient,,,185.5,92.75,,179.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,166.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,126.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,111.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,149.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,164.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,122.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,150.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,170.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,176.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,179.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,120.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,111.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,111.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,166.95,
OBS 1 MODERATE,14880020,CDM,762,RC,,,outpatient,,,47.75,23.88,,46.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,38.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,43.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,45.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,46.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.65,90,
OBS 2 INTERMEDIATE,14880022,CDM,762,RC,,,outpatient,,,56.25,28.13,,54.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,45.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,51.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,53.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,90,
OBS 3 EXTENSIVE,14880024,CDM,762,RC,,,outpatient,,,55,27.5,,53.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,33,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,33,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,44.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,50.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,52.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,53.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,33,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,33,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,33,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33,90,
OBS 1 INITIAL,14880030,CDM,762,RC,,,outpatient,,,278.5,139.25,,270.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,190.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,224.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,246.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,184.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,225.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,256.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,264.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,270.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,181.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,167.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,250.65,
OBS 2 INITIAL,14880032,CDM,762,RC,,,outpatient,,,348.25,174.13,,337.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,208.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,208.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,253.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,237.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,208.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,281.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,281.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,308.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,230.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,282.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,320.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,330.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,337.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,226.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,208.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,208.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,208.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,208.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,313.43,
OBS 3 INITIAL,14880034,CDM,762,RC,,,outpatient,,,418.25,209.13,,405.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,376.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,376.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,376.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,304.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,285.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,337.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,337.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,370.61,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,277.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,338.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,384.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,397.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,405.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,271.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,376.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,250.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,376.43,
OBS SUBSEQUENT HOURS (25+),14880040,CDM,762,RC,,,outpatient,,,57.25,28.63,,55.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,39.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,34.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,46.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,52.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,54.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,55.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,34.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,34.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.35,90,
OBS TELEMETRY SUBSEQUENT 25+,14880042,CDM,762,RC,,,outpatient,,,69.25,34.63,,67.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,41.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,45.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,56.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,63.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,65.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,67.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,41.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,41.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.55,90,
OBS MONITOR SUBSEQUENT (25+),14880044,CDM,762,RC,,,outpatient,,,70.5,35.25,,68.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,57.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,64.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,68.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,42.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.3,90,
IV INF/HYD INIT 31-60 MIN MOD 59,14896360,CDM,450,RC,,,outpatient,,,274.75,137.38,,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.28,
IV HYD EACH ADDTL HR MOD 59,14896361,CDM,450,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",14896365,CDM,450,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",14896366,CDM,450,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
ADDTL SEQUENT INF UP-1HR MOD 59,14896367,CDM,450,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
CONCURRENT INFUSION MOD 59,14896368,CDM,450,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
THER INJ SQ OR IM MOD 59,14896372,CDM,450,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
THER INJ INTRA-ARTERIAL MOD 59,14896373,CDM,450,RC,,,outpatient,,,50.75,25.38,,49.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,41.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,46.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,48.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,49.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",14896374,CDM,450,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",14896375,CDM,450,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-same drug add on",14896376,CDM,450,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,102.86,
PORT FLUSH ONLY MOD 59,14896523,CDM,450,RC,,,outpatient,,,92.5,46.25,,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,74.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,102.86,
"Debridement (for example, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps)",14897597,CDM,450,RC,,,outpatient,,,110,55,,106.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.16,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,99,90,,,percent of total billed charges,Pays at 90% of total billed charges,99,90,,,percent of total billed charges,Pays at 90% of total billed charges,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,75.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,72.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,89.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,101.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,104.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,106.7,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99,90,,,percent of total billed charges,Pays at 90% of total billed charges,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,66,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
MOD SEDATION INITIAL 15 MIN <5 YRS AGE,14899151,CDM,450,RC,,,outpatient,,,105.25,52.63,,102.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,71.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,69.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,85.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,96.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,99.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,102.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,63.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
MOD SEDATION INITIAL 15 MIN 5 OR > YRS A,14899152,CDM,450,RC,,,outpatient,,,77.25,38.63,,74.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.16,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,69.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,46.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,51.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,62.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,71.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,73.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,46.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,46.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.35,102.86,
MOD SEDATION EACH ADDTL 15 MIN,14899153,CDM,450,RC,,,outpatient,,,22,11,,21.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,19.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,21.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,13.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.2,102.86,
CATH FOR SPECIMEN COLLECTION,15200130,CDM,300,RC,,,outpatient,,,34.5,17.25,,33.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,31.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,32.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,,,,,Other,Not Separately reimbursable,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.57,100,
Outpatient visit of established patient not requiring a physician,18000001,CDM,510,RC,,,outpatient,,,26.75,13.38,,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,102.86,
Outpatient visit of established patient requiring a physician,18000002,CDM,510,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,102.86,
"Established patient office or other outpatient visit, typically 15 minutes",18000003,CDM,510,RC,,,outpatient,,,40.25,20.13,,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,102.86,
"Established patient office or other outpatient visit, typically 25 minutes",18000004,CDM,510,RC,,,outpatient,,,65.5,32.75,,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,53.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,60.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,62.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,102.86,
"Established patient office or other outpatient, visit typically 40 minutes",18000005,CDM,510,RC,,,outpatient,,,99,49.5,,96.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,80.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,91.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,94.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,96.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,102.86,
SA PFIZER COVID 19 VAC ADMIN 1ST DOSE,18000019,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
SA PFIZER COVID 19 VAC ADMIN 3RD DOSE,18000025,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
SA PFIZER COVID 19 VAC ADMIN 2ND DOSE,18000029,CDM,771,RC,,,outpatient,,,88.25,44.13,,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,81.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,90,
Immunization administration by a medical assistant or nurse,18000031,CDM,771,RC,,,outpatient,,,28.25,14.13,,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,102.86,
Outpatient visit of established patient requiring a physician,18000032,CDM,510,RC,,,outpatient,,,181.75,90.88,,176.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,163.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,163.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.24,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,124.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,161.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,120.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,147.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,167.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,172.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,176.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,118.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,109.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,163.58,
Outpatient visit of established patient not requiring a physician,18000034,CDM,510,RC,,,outpatient,,,37,18.5,,35.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,34.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,22.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.2,102.86,
Immunization administration by a medical assistant or nurse,18000035,CDM,771,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,102.86,
Immunization administration by a medical assistant or nurse,18000040,CDM,771,RC,,,outpatient,,,28.25,14.13,,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",18000041,CDM,510,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
IV INF/HYD INT UP-1HR,18000045,CDM,510,RC,,,outpatient,,,274.75,137.38,,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.28,
IV HYD EA ADD HR,18000047,CDM,510,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",18000049,CDM,510,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",18000051,CDM,510,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
ADDTL SEQUENT INF UP 1HR,18000053,CDM,510,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
CONCURRENT INFUSION,18000055,CDM,510,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
THER INJ SQ OR IM,18000057,CDM,510,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
THER INJ INTRA-ARTERIAL,18000059,CDM,510,RC,,,outpatient,,,50.75,25.38,,49.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,41.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,46.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,48.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,49.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",18000061,CDM,510,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",18000063,CDM,510,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
PORT FLUSH ONLY,18000079,CDM,510,RC,,,outpatient,,,92.5,46.25,,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,74.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,102.86,
CATH /NONDWELLING,18000083,CDM,510,RC,,,outpatient,,,113,56.5,,109.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,101.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,103.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,107.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,109.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
CATH /INDWELLING /SIMPLE,18000087,CDM,510,RC,,,outpatient,,,135.25,67.63,,131.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.57,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,121.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,92.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,109.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,124.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,131.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.73,
SA MODER COVID 19 VAC ADMIN 1ST DOSE,18000119,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
SA MODER COVID 19 VAC ADMIN 2ND DOSE,18000129,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
SA MODER COVID 19 VAC ADMIN 3RD DOSE,18000139,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
IV INFUSION BAMLAN/ESTESEV INF/POST MON,18000245,CDM,510,RC,,,outpatient,,,643.25,321.63,,623.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,385.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,578.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,578.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,385.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,468.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,439.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,385.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,519.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,519.23,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,569.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,426.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,521.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,591.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,611.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,623.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,418.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,385.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,385.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,385.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,578.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,385.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,385.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,578.93,
SA JANSSEN COVID 19 VAC ADMIN,18000319,CDM,771,RC,,,outpatient,,,88.25,44.13,,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,81.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,90,
SA JANSSEN COVID 19 VAC ADMIN BOOSTER,18000349,CDM,771,RC,,,outpatient,,,88.25,44.13,,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,81.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,90,
SA PEDS PFIZER COVID19 VAC ADMIN 1ST DOS,18000719,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
SA PEDS PFIZER COVID19 VAC ADMIN 2ND DOS,18000729,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
SA PFIZER COVID 19 VAC ADMIN BOOSTER,18000949,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",18001807,CDM,510,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",18001817,CDM,510,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",18001827,CDM,510,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",18001837,CDM,510,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
IV INF/HYD INT UP-1HR MOD XE,18001900,CDM,510,RC,,,outpatient,,,274.75,137.38,,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.28,
IV HYD EA ADD HR MOD XE,18001901,CDM,510,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",18001902,CDM,510,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",18001903,CDM,510,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
ADDTL SEQUENT INF UP 1HR MOD XE,18001904,CDM,510,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
CONCURRENT INFUSION MOD XE,18001905,CDM,510,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
THER INJ SQ OR IM MOD XE,18001906,CDM,510,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",18001907,CDM,510,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",18001908,CDM,510,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
IV INF/HYD INT UP-1HR MOD XS,18001910,CDM,510,RC,,,outpatient,,,274.75,137.38,,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.28,
IV HYD EA ADD HR MOD XS,18001911,CDM,510,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",18001912,CDM,510,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",18001913,CDM,510,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
ADDTL SEQUENT INF UP 1HR MOD XS,18001914,CDM,510,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
CONCURRENT INFUSION MOD XS,18001915,CDM,510,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
THER INJ SQ OR IM MOD XS,18001916,CDM,510,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",18001917,CDM,510,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",18001918,CDM,510,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
IV INF/HYD INT UP-1HR MOD XU,18001920,CDM,510,RC,,,outpatient,,,274.75,137.38,,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.28,
IV HYD EA ADD HR MOD XU,18001921,CDM,510,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",18001922,CDM,510,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",18001923,CDM,510,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
ADDTL SEQUENT INF UP 1HR MOD XU,18001924,CDM,510,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
CONCURRENT INFUSION MOD XU,18001925,CDM,510,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
THER INJ SQ OR IM MOD XU,18001926,CDM,510,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",18001927,CDM,510,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",18001928,CDM,510,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
IV INF/HYD INT UP-1HR MOD XP,18001930,CDM,510,RC,,,outpatient,,,274.75,137.38,,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.28,
IV HYD EA ADD HR MOD XP,18001931,CDM,510,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",18001932,CDM,510,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",18001933,CDM,510,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
ADDTL SEQUENT INF UP 1HR MOD XP,18001934,CDM,510,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
CONCURRENT INFUSION MOD XP,18001935,CDM,510,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
THER INJ SQ OR IM MOD XP,18001936,CDM,510,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",18001937,CDM,510,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",18001938,CDM,510,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
IV INF/HYD INT UP-1HR MOD 59,18006360,CDM,510,RC,,,outpatient,,,274.75,137.38,,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.28,
IV HYD EA ADD HR MOD 59,18006361,CDM,510,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",18006365,CDM,510,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",18006366,CDM,510,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
ADDTL SEQUENT INF UP 1HR MOD 59,18006367,CDM,510,RC,,,outpatient,,,162.25,81.13,,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,110.74,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,130.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,143.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,97.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.03,
CONCURRENT INFUSION MOD 59,18006368,CDM,510,RC,,,outpatient,,,87.75,43.88,,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,59.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,80.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.65,102.86,
THER INJ SQ OR IM MOD 59,18006372,CDM,510,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
THER INJ INTRA-ARTERIAL MOD 59,18006373,CDM,510,RC,,,outpatient,,,50.75,25.38,,49.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,41.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,46.69,92,,,percent of total billed charges,Pays at 92% of total billed charges,48.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,49.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,30.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.45,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",18006374,CDM,510,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",18006375,CDM,510,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
PORT FLUSH ONLY MOD 59,18006523,CDM,510,RC,,,outpatient,,,92.5,46.25,,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,74.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,102.86,
CATH FOR SEPECIMEN COLL,18009612,CDM,300,RC,,,outpatient,,,34.5,17.25,,33.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,31.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,32.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,,,,,Other,Not Separately reimbursable,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.57,100,
INSERT TUNNELED CV CATH OUTSIDE SERVICE,18036569,CDM,510,RC,,,outpatient,,,1723,861.5,,1671.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1550.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1550.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1253.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1175.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1390.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1390.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1526.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1142.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1395.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1585.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,1636.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,1671.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,1119.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1550.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1033.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1550.7,
REMOVAL TUNNELED CENTRAL VEN CATH WO SUB,18036589,CDM,510,RC,,,outpatient,,,522.25,261.13,,506.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,313.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,470.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,470.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,379.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,356.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,313.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,421.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,421.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,462.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,346.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,423.02,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,480.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,496.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,506.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,339.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,313.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,313.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,470.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,313.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,313.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,470.03,
VENOUS ACCESS DEVICE COLL BLOOD,18036591,CDM,510,RC,,,outpatient,,,61.75,30.88,,59.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.04,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,55.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,42.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,40.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,50.02,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,56.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,58.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,59.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,37.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.05,102.86,
COLL BLOOD CENTRAL/PERIPHERAL CATH,18036592,CDM,510,RC,,,outpatient,,,63.25,31.63,,61.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,56.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,51.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,58.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,60.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,61.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,37.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.95,102.86,
Ultrasound of bladder to measure urine capacity,18051798,CDM,510,RC,,,outpatient,,,43,21.5,,41.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,38.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,34.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,39.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,25.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.8,102.86,
IMMUNIZATION ADMIN ADDTL,18090472,CDM,771,RC,,,outpatient,,,22.75,11.38,,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,102.86,
Allergy shot-1 shot,18095115,CDM,510,RC,,,outpatient,,,35.75,17.88,,34.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.02,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,102.86,
Multiple allergy shots,18095117,CDM,510,RC,,,outpatient,,,46,23,,44.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,37.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,42.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",18096374,CDM,510,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
CHEMO ADMIN SQ/IM HORMOL ANTI-NEOPLAST,18096402,CDM,510,RC,,,outpatient,,,67.75,33.88,,65.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.45,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,44.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,54.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,62.33,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,65.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,40.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.65,102.86,
Outpatient visit of established patient not requiring a physician,18200001,CDM,510,RC,,,outpatient,,,26.75,13.38,,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,102.86,
Outpatient visit of established patient requiring a physician,18200002,CDM,510,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,102.86,
"Established patient office or other outpatient visit, typically 15 minutes",18200003,CDM,510,RC,,,outpatient,,,40.25,20.13,,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,102.86,
"Established patient office or other outpatient visit, typically 25 minutes",18200004,CDM,510,RC,,,outpatient,,,65.5,32.75,,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,53.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,60.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,62.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,102.86,
"Established patient office or other outpatient, visit typically 40 minutes",18200005,CDM,510,RC,,,outpatient,,,99,49.5,,96.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,80.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,91.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,94.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,96.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,102.86,
CATH /NONDWELLING,18251701,CDM,510,RC,,,outpatient,,,113,56.5,,109.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,101.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,103.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,107.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,109.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Test to measure electrical activity of muscles or nerves in 1 limb,19500112,CDM,922,RC,,,outpatient,,,237,118.5,,229.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,213.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,161.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,191.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,191.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,210.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,157.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,191.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,218.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,225.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,229.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,154.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,213.3,
Test to measure electrical activity of muscles or nerves in 2 limb,19500114,CDM,922,RC,,,outpatient,,,237,118.5,,229.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.64,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,213.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,161.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,191.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,191.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,210.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,157.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,191.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,218.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,225.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,229.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,154.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,213.3,
EMG 3 EXTREMITY TECH,19500116,CDM,922,RC,,,outpatient,,,237,118.5,,229.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.14,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,213.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,161.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,191.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,191.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,210.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,157.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,191.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,218.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,225.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,229.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,154.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,213.3,
EMG FOUR EXTREMITY TECH,19500118,CDM,922,RC,,,outpatient,,,237,118.5,,229.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,225.9,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,213.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,213.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,161.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,191.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,191.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,210.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,157.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,191.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,218.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,225.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,229.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,154.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,142.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,213.3,
VISUAL E POTENTIAL,19500132,CDM,920,RC,,,outpatient,,,101.5,50.75,,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.8,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,82.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,93.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Injection of medication into a tendon or ligament,19500143,CDM,510,RC,,,outpatient,,,27.75,13.88,,26.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,102.86,
HBPC INJECTION CARPAL TUNNEL,19500145,CDM,510,RC,,,outpatient,,,40.5,20.25,,39.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,36.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.3,102.86,
Injection of medication into the tendon/ligament origin,19500147,CDM,510,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,102.86,
HBPC TRIGGER PT INJ MUS 1 OR 2,19500149,CDM,510,RC,,,outpatient,,,36.5,18.25,,35.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.94,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,33.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,102.86,
Injection of medication into an area that triggers pain,19500151,CDM,510,RC,,,outpatient,,,41.75,20.88,,40.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,38.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,39.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.05,102.86,
"Puncture aspiration of abscess, hematoma, bulla, or cyst",19500160,CDM,510,RC,,,outpatient,,,68.25,34.13,,66.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,45.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,55.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,62.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,66.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,102.86,
NEURO HBPC SPIL TAP LUMBAR DX,19500341,CDM,510,RC,,,outpatient,,,134,67,,129.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,120.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,80.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,88.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,108.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,123.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,127.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,129.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,80.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,80.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,120.6,
Draining or injecting medication into a small joint/bursa without ultrasound,19500600,CDM,510,RC,,,outpatient,,,26.25,13.13,,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,102.86,
Draining or injecting medication into a large joint/bursa without ultrasound,19500605,CDM,510,RC,,,outpatient,,,47,23.5,,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,38.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,43.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,102.86,
Draining or injecting medication into a major joint/bursa without ultrasound,19500610,CDM,510,RC,,,outpatient,,,77.5,38.75,,75.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,69.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,51.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,62.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,71.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,73.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,75.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.5,102.86,
Injection of substance into spil cal of lower back or sacrum using imaging guidance,19502322,CDM,510,RC,,,outpatient,,,123,61.5,,119.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.97,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,110.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,99.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,113.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,119.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,73.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,110.7,
NE HBPC INJECTION ANESTHET AGENT FEM NER,19504447,CDM,510,RC,,,outpatient,,,137.25,68.63,,133.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.16,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.53,
NEEDLE ELECTROMYOGRAPHY EA EXT W NERVE C,19505885,CDM,922,RC,,,outpatient,,,137,68.5,,132.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,90.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,110.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,132.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.3,
Test to assess for nerve damage,19505886,CDM,922,RC,,,outpatient,,,137,68.5,,132.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.08,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,90.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,110.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,132.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.3,
NE HBPC CALITH REPOSITIONING PER DAY,19505992,CDM,510,RC,,,outpatient,,,8,4,,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.36,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,4.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.8,102.86,
NERVE CONDUCTION 1-2 STUDIES TECH,19515907,CDM,922,RC,,,outpatient,,,142.5,71.25,,138.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,128.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,97.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,94.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,115.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,131.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,135.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,138.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,92.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,128.25,
NERVE CONDUCTION 3-4 STUDIES TECH,19515908,CDM,922,RC,,,outpatient,,,142.5,71.25,,138.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.94,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,128.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,97.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,94.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,115.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,131.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,135.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,138.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,92.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,128.25,
NERVE CONDUCTION 5-6 STUDIES TECH,19515909,CDM,922,RC,,,outpatient,,,142.5,71.25,,138.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.94,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,128.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,97.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,94.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,115.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,131.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,135.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,138.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,92.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,128.25,
NERVE CONDUCTION 7-8 STUDIES TECH,19515910,CDM,922,RC,,,outpatient,,,142.5,71.25,,138.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.58,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,128.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,97.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,94.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,115.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,131.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,135.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,138.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,92.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,85.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,128.25,
NERVE CONDUCTION 13 OR MORE STUDIES TECH,19515913,CDM,922,RC,,,outpatient,,,263,131.5,,255.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,157.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,280.77,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,236.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,236.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,191.36,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,179.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,157.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,212.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,233.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,174.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,213.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,241.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,249.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,255.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,170.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,157.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,236.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,157.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,236.7,
NERVE CONDUCTION 9-10 STUDIES TECH,19519511,CDM,922,RC,,,outpatient,,,262.5,131.25,,254.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,157.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.01,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,236.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,236.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,191,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,179.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,157.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,211.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,211.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,232.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,174.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,212.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,241.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,249.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,254.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,170.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,157.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,236.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,157.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,236.25,
NERVE CONDUCTION 11-12 STUDIES TECH,19519512,CDM,922,RC,,,outpatient,,,263,131.5,,255.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,157.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,242.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,236.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,236.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,191.36,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,179.5,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,157.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,212.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,233.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,174.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,213.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,241.96,92,,,percent of total billed charges,Pays at 92% of total billed charges,249.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,255.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,170.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,157.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,236.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,157.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,236.7,
NEURO HBPC SPIL TAP THERAPEUTIC,19592272,CDM,510,RC,,,outpatient,,,134,67,,129.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,120.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,80.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.74,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,88.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,108.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,123.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,127.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,129.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,80.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,80.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,120.6,
Outpatient visit of established patient not requiring a physician,19800001,CDM,510,RC,,,outpatient,,,26.75,13.38,,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,102.86,
Outpatient visit of established patient requiring a physician,19800002,CDM,510,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,102.86,
"Established patient office or other outpatient visit, typically 15 minutes",19800003,CDM,510,RC,,,outpatient,,,40.25,20.13,,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,102.86,
"Established patient office or other outpatient visit, typically 25 minutes",19800004,CDM,510,RC,,,outpatient,,,65.5,32.75,,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,53.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,60.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,62.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,102.86,
"Established patient office or other outpatient, visit typically 40 minutes",19800005,CDM,510,RC,,,outpatient,,,99,49.5,,96.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,80.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,91.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,94.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,96.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,102.86,
Outpatient visit of established patient not requiring a physician,20000001,CDM,510,RC,,,outpatient,,,26.75,13.38,,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,102.86,
Outpatient visit of established patient requiring a physician,20000002,CDM,510,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,102.86,
"Established patient office or other outpatient visit, typically 15 minutes",20000003,CDM,510,RC,,,outpatient,,,40.25,20.13,,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,102.86,
"Established patient office or other outpatient visit, typically 25 minutes",20000004,CDM,510,RC,,,outpatient,,,65.5,32.75,,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,53.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,60.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,62.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,102.86,
"Established patient office or other outpatient, visit typically 40 minutes",20000005,CDM,510,RC,,,outpatient,,,99,49.5,,96.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,80.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,91.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,94.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,96.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,102.86,
DEFINITY VIAL 1.8ML,20000006,CDM,272,RC,,,outpatient,,,236.25,118.13,,229.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,141.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,212.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,212.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,161.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,141.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,190.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,209.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,156.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,191.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,217.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,224.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,229.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,153.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,141.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,141.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,141.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,212.63,
Fine Needle Aspiration Biopsy without imaging,20000021,CDM,510,RC,,,outpatient,,,165.5,82.75,,160.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.52,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,148.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,148.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,112.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,99.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,109.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,134.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,152.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,157.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,160.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,107.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,99.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,99.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,148.95,
PAK ABLATION VEIN,20000025,CDM,272,RC,,,outpatient,,,122.75,61.38,,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.83,30,,,percent of total billed charges,Pays at 30% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,99.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,110.48,
Incision and draige of abscess; simple or single and complex or multiple,20000060,CDM,510,RC,,,outpatient,,,37.5,18.75,,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.18,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,34.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,102.86,
One sided or limited bilateral study,20000071,CDM,929,RC,,,outpatient,,,794.25,397.13,,770.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,476.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,714.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,714.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,714.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,476.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,577.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,542.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,476.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,641.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,641.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,703.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,526.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,643.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,730.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,754.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,770.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,516.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,476.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,476.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,476.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,714.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,476.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,476.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,714.83,
GS HBPC INCISION DRAIGE PILONIDAL CYST,20000080,CDM,510,RC,,,outpatient,,,112.25,56.13,,108.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.1,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,101.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,103.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
GS HBPC ADJUST GASTRIC BAND DIAM SUBC,20000083,CDM,510,RC,,,outpatient,,,37.5,18.75,,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.76,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,34.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,
ARCOS 16150mm SPL TPR DIST,20000084,CDM,278,RC,,,outpatient,,,6780.5,3390.25,,6577.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,4068.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2034.15,30,,,percent of total billed charges,Pays at 30% of total billed charges,6102.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,6102.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,4068.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4933.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4627.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4068.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5473.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5473.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6008.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4495.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5492.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6238.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,6441.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,6577.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,4407.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,4068.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4068.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4068.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6102.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,4068.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4068.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,6102.45,
ARCOS CON SZ STD 70MM,20000085,CDM,278,RC,,,outpatient,,,13154.75,6577.38,,12760.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,7892.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3946.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,11839.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,11839.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,7892.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9571.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8978.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7892.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10618.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10618.51,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11656.42,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8721.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10655.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12102.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,12497.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,12760.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,8550.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,7892.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7892.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7892.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11839.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,7892.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7892.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,11839.28,
COROR MOD 28MM HD38MM NK,20000086,CDM,278,RC,,,outpatient,,,1123,561.5,,1089.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,336.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,1010.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,1010.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,817.09,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,766.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,906.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,906.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,995.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,744.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,909.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1033.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,1066.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,1089.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,729.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1010.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,673.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1010.7,
BIPOLAR SHELL 53 MM OD,20000087,CDM,278,RC,,,outpatient,,,674,337,,653.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,606.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,606.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,490.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,460.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,544.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,544.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,597.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,446.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,545.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,620.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,640.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,653.78,97,,,percent of total billed charges,Pays at 97% of total billed charges,438.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,606.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,404.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,606.6,
BIPOLAR LINER 53/54/55 OD X 28MM ID,20000088,CDM,278,RC,,,outpatient,,,449.25,224.63,,435.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,404.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,404.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,326.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,306.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,362.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,362.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,398.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,297.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,363.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,413.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,426.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,435.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,292.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,404.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,269.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,404.33,
CABLE READY CABLE ASSY CERCLAGE 1.8MMX91,20000089,CDM,278,RC,,,outpatient,,,638.5,319.25,,619.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,383.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,191.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,574.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,574.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,383.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,464.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,435.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,383.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,515.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,515.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,565.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,423.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,517.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,587.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,606.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,619.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,415.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,383.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,383.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,383.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,574.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,383.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,383.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,574.65,
FLIP CUTTER II,20000090,CDM,272,RC,,,outpatient,,,932.5,466.25,,904.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,559.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,279.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,839.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,839.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,559.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,678.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,636.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,559.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,752.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,752.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,826.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,618.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,755.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,857.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,885.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,904.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,606.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,559.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,559.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,559.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,839.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,559.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,559.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,839.25,
ACL PLUS KIT,20000091,CDM,272,RC,,,outpatient,,,1347.75,673.88,,1307.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,404.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,1212.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,1212.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,980.62,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,919.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1087.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1087.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1194.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,893.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1091.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1239.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,1280.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,1307.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,876.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1212.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,808.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1212.98,
PSN FEM CMT CCR STD SZ8R,20000092,CDM,278,RC,,,outpatient,,,4492,2246,,4357.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1347.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3268.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3065.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3625.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3625.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3980.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2978.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3638.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4132.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,4267.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,4357.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,2919.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4042.8,
PSN FEM PS CMT CCR NRW SZ11R,20000093,CDM,278,RC,,,outpatient,,,4492,2246,,4357.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3268.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3065.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3625.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3625.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3980.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2978.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3638.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4132.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,4267.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,4357.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,2919.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4042.8,
PSN TIB STM 5 DEG SZ FR,20000094,CDM,278,RC,,,outpatient,,,1909.25,954.63,,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1389.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1303.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1691.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1265.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1546.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1756.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,1813.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1241.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1718.33,
PSN ASF PS 10MM VE R 10 11 EF,20000095,CDM,278,RC,,,outpatient,,,2470.75,1235.38,,2396.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1797.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1686.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1994.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1994.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2189.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1638.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2001.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2273.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,2347.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,2396.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,1605.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2223.68,
PSN TIB STM 5 DEG SZ F R,20000096,CDM,278,RC,,,outpatient,,,1909.25,954.63,,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,572.78,30,,,percent of total billed charges,Pays at 30% of total billed charges,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1389.17,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1303.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1541.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1691.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1265.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1546.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1756.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,1813.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,1851.97,97,,,percent of total billed charges,Pays at 97% of total billed charges,1241.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1718.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1145.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1718.33,
PSN ASF PS 11MM VE R 6-9 EF,20000097,CDM,278,RC,,,outpatient,,,2470.75,1235.38,,2396.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,741.23,30,,,percent of total billed charges,Pays at 30% of total billed charges,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1797.72,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1686.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1994.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1994.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2189.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1638.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2001.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2273.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,2347.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,2396.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,1605.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2223.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1482.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2223.68,
MICRO CORKSCREW,20000098,CDM,278,RC,,,outpatient,,,637.25,318.63,,618.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,382.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,191.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,573.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,573.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,382.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,463.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,434.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,382.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,514.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,514.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,564.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,422.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,516.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,586.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,605.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,618.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,414.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,382.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,382.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,382.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,573.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,382.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,382.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,573.53,
PLATE VOLAR,20000099,CDM,278,RC,,,outpatient,,,1251.25,625.63,,1213.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,750.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,375.38,30,,,percent of total billed charges,Pays at 30% of total billed charges,1126.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,1126.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,750.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,910.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,853.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,750.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1010.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1010.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1108.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,829.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1013.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1151.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,1188.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,1213.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,813.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,750.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,750.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,750.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1126.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,750.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,750.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1126.13,
SCREW LO PRO TI 3.5MMX12MM,20000100,CDM,278,RC,,,outpatient,,,135.25,67.63,,131.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,121.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,92.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,109.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,124.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,131.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.73,
SCREW LO PRO TI 3.5MMX14MM,20000101,CDM,278,RC,,,outpatient,,,135.25,67.63,,131.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,121.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,92.31,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,109.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.85,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,124.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,131.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,81.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.73,
SCREW LOCKING   TITAINIUM 3.5MMX14MM,20000102,CDM,278,RC,,,outpatient,,,337,168.5,,326.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,202.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,299.03,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,303.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,303.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,245.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,230,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,202.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,272.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,272.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,298.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,223.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,272.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,310.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,320.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,326.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,219.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,202.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,202.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,303.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,202.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,202.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,303.3,
SUTURE LASSO GEN 2,20000120,CDM,272,RC,,,outpatient,,,359.5,179.75,,348.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,323.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,323.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,261.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,245.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,290.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,290.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,318.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,238.35,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,291.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,330.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,341.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,348.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,233.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,323.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,215.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,323.55,
GS HBPC INCISION REMOVAL FB SUBC TISS CO,20000121,CDM,510,RC,,,outpatient,,,96,48,,93.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,255.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,86.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,65.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,63.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,77.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,88.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,91.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,93.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.6,102.86,
SUTURE LASSO GEN 3,20000122,CDM,272,RC,,,outpatient,,,393.25,196.63,,381.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.98,30,,,percent of total billed charges,Pays at 30% of total billed charges,353.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,353.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,286.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,268.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,317.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,317.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,348.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,260.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,318.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,361.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,373.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,381.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,255.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,353.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,235.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,353.93,
LMA MASK SZ 3 INTUBATION-AN,20000123,CDM,272,RC,,,outpatient,,,39.5,19.75,,38.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,36.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,37.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,38.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.7,90,
LMA MASK SZ 4 INTUBATION-AN,20000124,CDM,272,RC,,,outpatient,,,39.5,19.75,,38.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,36.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,37.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,38.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.7,90,
LMA MASK SZ 5 INTUBATION-AN,20000125,CDM,272,RC,,,outpatient,,,39.5,19.75,,38.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.85,30,,,percent of total billed charges,Pays at 30% of total billed charges,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,36.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,37.53,95,,,percent of total billed charges,Pays at 95% of total billed charges,38.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.68,65,,,percent of total billed charges,Pays at 65% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,23.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.7,90,
ACL FUNCTIOL BRACE,20000126,CDM,270,RC,,,outpatient,,,1241.5,620.75,,1204.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,372.45,30,,,percent of total billed charges,Pays at 30% of total billed charges,1117.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,1117.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,903.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,847.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1002.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1002.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1100.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,823.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1005.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1142.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,1179.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,1204.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,806.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1117.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,744.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1117.35,
SUTURE TAK BIO COMP,20000127,CDM,272,RC,,,outpatient,,,954.75,477.38,,926.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,572.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,286.43,30,,,percent of total billed charges,Pays at 30% of total billed charges,859.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,859.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,572.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,694.68,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,651.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,572.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,770.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,770.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,846,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,633,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,773.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,878.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,907.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,926.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,620.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,572.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,572.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,572.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,859.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,572.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,572.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,859.28,
"Incision and draige of hematoma, seroma or fluid collection",20000140,CDM,510,RC,,,outpatient,,,80,40,,77.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,76,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52,65,,,percent of total billed charges,Pays at 65% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,102.86,
DRILL BIT TWISTED 2.0,20000141,CDM,270,RC,,,outpatient,,,121.75,60.88,,118.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,98.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,115.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,118.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,109.58,
DRILL BIT TWISTED 2.7,20000142,CDM,270,RC,,,outpatient,,,121.75,60.88,,118.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.28,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,98.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,115.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,118.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,109.58,
K WIRE double trocar  0.45 6 LONG,20000143,CDM,278,RC,,,outpatient,,,13.75,6.88,,13.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.25,90,
K WIRE double trocar  0.62 6 LONG,20000144,CDM,278,RC,,,outpatient,,,13.75,6.88,,13.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.13,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,9.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.65,92,,,percent of total billed charges,Pays at 92% of total billed charges,13.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.25,90,
K WIRE double trocar  0.45 9 LONG,20000145,CDM,278,RC,,,outpatient,,,15.75,7.88,,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,90,
K WIRE double trocar  0.62 9 LONG,20000146,CDM,278,RC,,,outpatient,,,15.75,7.88,,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,90,
K WIRE double trocar  0.28 6  LONG,20000147,CDM,278,RC,,,outpatient,,,15.75,7.88,,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,90,
KNEE BRACE ACL  LG,20000150,CDM,270,RC,,,outpatient,,,1168,584,,1132.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,700.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,350.4,30,,,percent of total billed charges,Pays at 30% of total billed charges,1051.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,1051.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,700.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,849.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,797.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,700.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,942.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,942.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1034.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,774.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,946.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1074.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,1109.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,1132.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,759.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,700.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,700.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,700.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1051.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,700.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,700.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1051.2,
ALLOGRAFT GRAFT LINK GRAC 5.0 250MM,20000151,CDM,272,RC,,,outpatient,,,2745.5,1372.75,,2663.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,1647.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,823.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,2470.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,2470.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,1647.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1997.63,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1873.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1647.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2216.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2216.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2432.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1820.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2223.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2525.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,2608.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,2663.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,1784.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,1647.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1647.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1647.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2470.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,1647.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1647.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2470.95,
SCREW 3.5X60MM,20000182,CDM,278,RC,,,outpatient,,,104.25,52.13,,101.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,93.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,93.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,71.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,62.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.15,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,69.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,84.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,95.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,99.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,101.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,62.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,62.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,62.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,93.83,
SCREW 2.7X20MM,20000183,CDM,278,RC,,,outpatient,,,64,32,,62.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,51.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,58.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,60.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,62.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.4,90,
SCREW 2.7X22MM,20000184,CDM,278,RC,,,outpatient,,,64,32,,62.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,51.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,58.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,60.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,62.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.4,90,
SCREW 2.7X24MM,20000185,CDM,278,RC,,,outpatient,,,64,32,,62.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.2,30,,,percent of total billed charges,Pays at 30% of total billed charges,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,51.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,58.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,60.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,62.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.4,90,
DRILL BIT,20000186,CDM,272,RC,,,outpatient,,,314.5,157.25,,305.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,188.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.35,30,,,percent of total billed charges,Pays at 30% of total billed charges,283.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,283.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,188.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,214.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,188.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,253.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,253.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,278.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,208.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,254.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,289.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,298.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,305.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,204.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,188.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,188.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,283.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,188.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,188.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,283.05,
DRILL BIT,20000187,CDM,272,RC,,,outpatient,,,184.25,92.13,,178.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,110.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,165.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,165.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,125.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,110.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,148.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,163.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,122.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,149.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,169.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,175.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,178.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,119.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,110.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,110.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,165.83,
K WIRE,20000188,CDM,272,RC,,,outpatient,,,122.5,61.25,,118.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,110.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,99.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,118.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,110.25,
K WIRE,20000189,CDM,272,RC,,,outpatient,,,122.5,61.25,,118.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,110.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,99.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,118.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,73.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,110.25,
DRESSING TOPSHEET FENESTRATED,20000190,CDM,272,RC,,,outpatient,,,28.5,14.25,,27.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,17.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.1,90,
NEEDLE AUTO CUTTING 18GA,20000191,CDM,272,RC,,,outpatient,,,47.25,23.63,,45.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,42.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,38.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,43.47,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,28.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.35,90,
NEEDLE CHIBA MARKING NEEDLE 22GA,20000192,CDM,272,RC,,,outpatient,,,38.25,19.13,,37.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,35.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,36.34,95,,,percent of total billed charges,Pays at 95% of total billed charges,37.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.86,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,22.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.95,90,
SRE POLYPECTOMY SHORT THROW 12.5,20000193,CDM,272,RC,,,outpatient,,,45.5,22.75,,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,41.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,90,
SRE POLYPECTOMY SHORT THROW 25MM,20000194,CDM,272,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
SCREW TENODESIS PEEK,20000198,CDM,278,RC,,,outpatient,,,640.25,320.13,,621.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,576.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,576.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,465.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,436.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,516.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,516.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,567.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,424.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,518.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,589.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,608.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,621.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,416.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,576.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,576.23,
KIT INSTRUMENT TENDOSIS,20000199,CDM,278,RC,,,outpatient,,,640.25,320.13,,621.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,192.08,30,,,percent of total billed charges,Pays at 30% of total billed charges,576.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,576.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,465.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,436.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,516.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,516.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,567.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,424.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,518.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,589.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,608.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,621.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,416.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,576.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,384.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,576.23,
LIGA CLIP EXTRA,20000297,CDM,272,RC,,,outpatient,,,119.75,59.88,,116.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.93,30,,,percent of total billed charges,Pays at 30% of total billed charges,107.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,81.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,113.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,107.78,
ECHO POR FMRL RED LAT RPPNC 11X135,20000440,CDM,278,RC,,,outpatient,,,1410.5,705.25,,1368.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,846.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1269.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,1269.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,846.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1026.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,962.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,846.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1138.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1138.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1249.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,935.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1142.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1297.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,1339.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,1368.19,97,,,percent of total billed charges,Pays at 97% of total billed charges,916.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,846.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,846.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,846.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1269.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,846.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,846.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1269.45,
CATH KIT FEMALE EXTERL   PUREWICK,20000454,CDM,272,RC,,,outpatient,,,34.25,17.13,,33.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.28,30,,,percent of total billed charges,Pays at 30% of total billed charges,30.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,31.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,32.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.55,90,
COMP LK SCR 3.5 HEX 4.75 X25MM,20000470,CDM,278,RC,,,outpatient,,,162.75,81.38,,157.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,111.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,131.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,144.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,107.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,131.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,149.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,154.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,157.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,97.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,146.48,
GS HBPC TRIGGER PT INJ MUS 1 OR 2,20000552,CDM,510,RC,,,outpatient,,,37.5,18.75,,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.94,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,34.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,102.86,
Draining or injecting medication into a large joint/bursa without ultrasound,20000605,CDM,510,RC,,,outpatient,,,48,24,,46.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,43.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,38.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,44.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,45.6,95,,,percent of total billed charges,Pays at 95% of total billed charges,46.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.2,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,28.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.8,102.86,
GS HBPC ARTHROCENTESIS ASP/INJ INTERM JT,20000611,CDM,510,RC,,,outpatient,,,53.5,26.75,,51.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,48.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,32.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,47.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,43.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,49.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,32.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,32.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.1,102.86,
GS MINOR PROCEDURE ROOM,20000761,CDM,761,RC,,,outpatient,,,517.5,258.75,,501.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,310.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,465.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,465.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,310.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,376.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,353.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,310.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,417.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,417.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,458.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,343.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,419.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,476.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,491.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,501.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,336.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,310.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,310.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,310.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,465.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,310.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,310.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,465.75,
DRILL BIT,20000826,CDM,272,RC,,,outpatient,,,743,371.5,,720.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,445.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,668.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,668.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,445.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,540.61,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,507.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,445.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,599.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,599.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,658.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,492.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,601.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,683.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,705.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,720.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,482.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,445.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,445.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,445.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,668.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,445.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,445.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,668.7,
US GS HBPC GUIDED NEEDLE PLAC RT,20000942,CDM,402,RC,,,outpatient,,,869,434.5,,842.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.2,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,782.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,782.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,632.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,593.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,701.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,701.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,770.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,576.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,703.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,799.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,825.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,842.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,564.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,782.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,782.1,
One sided or limited bilateral study,20000971,CDM,929,RC,,,outpatient,,,794.25,397.13,,770.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,476.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,714.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,714.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,714.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,476.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,577.9,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,542.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,476.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,641.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,641.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,703.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,526.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,643.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,730.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,754.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,770.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,516.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,476.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,476.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,476.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,714.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,476.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,476.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,714.83,
GS HBPC DEBRIDEMENT SKIN SUBCUTAN TISSUE,20001042,CDM,510,RC,,,outpatient,,,64,32,,62.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.69,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,51.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,58.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,60.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,62.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.4,102.86,
GS HBPC INCISIOL BX SKIN SINGLE LESION,20001106,CDM,510,RC,,,outpatient,,,346.5,173.25,,336.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,207.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,311.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,311.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,236.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,207.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,279.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,279.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,307.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,229.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,280.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,318.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,329.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,336.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,225.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,207.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,311.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,207.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,311.85,
"Removal of skin tags, multiple fibrocutaneous tags, any area",20001200,CDM,510,RC,,,outpatient,,,32.25,16.13,,31.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.66,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,29.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,29.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,30.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,31.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,19.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.35,102.86,
GS HBPC SHAVE EPID/DERMAL LES SING <.5 C,20001300,CDM,510,RC,,,outpatient,,,90.75,45.38,,88.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,81.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,60.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,73.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,83.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,86.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,88.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.45,102.86,
GS HBPC SHAVE EPID/DERMAL LES SING 0.6-1,20001301,CDM,510,RC,,,outpatient,,,101.25,50.63,,98.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.32,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,91.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,82.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,93.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
GS HBPC SHAVE EPID DERMAL LES 1.1-2.0 CM,20001302,CDM,510,RC,,,outpatient,,,112.25,56.13,,108.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.09,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,101.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,103.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
GS HBPC SHAVING EPIDERMAL/DERMAL LESION,20001306,CDM,510,RC,,,outpatient,,,90.75,45.38,,88.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.98,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,81.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,81.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,60.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,73.51,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,83.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,86.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,88.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,54.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.45,102.86,
GS HBPC SHAVING EPIDERM/DERM LES 0.5 CM<,20001310,CDM,510,RC,,,outpatient,,,96,48,,93.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,86.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,65.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,63.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,77.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,88.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,91.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,93.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.6,102.86,
SUTURE SURGIPRO 2-0 GS24,20001372,CDM,272,RC,,,outpatient,,,5.5,2.75,,5.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.65,30,,,percent of total billed charges,Pays at 30% of total billed charges,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,4.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,3.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,5.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,5.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.3,90,
GS HBPC EXCISION BEN LES 0.5 OR < CM TRU,20001400,CDM,510,RC,,,outpatient,,,96,48,,93.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,86.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,65.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,63.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,77.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,88.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,91.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,93.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.6,102.86,
Under Excision-Benign Lesions Procedures on the Skin 0.6-1 CM,20001401,CDM,510,RC,,,outpatient,,,101.25,50.63,,98.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,91.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,82.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,93.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
GS HBPC EXCISION BEN LES 1.1-2.0 CM TRUN,20001402,CDM,510,RC,,,outpatient,,,112.25,56.13,,108.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.57,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,101.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,103.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
GS HBPC EXCISION BENIGN <.5 CM,20001420,CDM,510,RC,,,outpatient,,,80,40,,77.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.75,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,76,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52,65,,,percent of total billed charges,Pays at 65% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,102.86,
GS HBPC EXCISION BENIGN LES 0.6-1.0 CM S,20001421,CDM,510,RC,,,outpatient,,,96,48,,93.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,86.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,65.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,63.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,77.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,88.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,91.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,93.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.6,102.86,
GS HBPC EXCISION BENIGN LES FACE/EAR/EYE,20001440,CDM,510,RC,,,outpatient,,,74.75,37.38,,72.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,49.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,60.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,68.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,72.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,102.86,
GS HBPC EXCISION MALIG 0.6-1.0 CM,20001601,CDM,510,RC,,,outpatient,,,277.25,138.63,,268.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,166.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,212.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,249.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,249.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,189.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,166.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,223.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,245.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,183.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,224.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,255.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,263.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,268.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,180.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,166.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,249.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,166.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,249.53,
GS HBPC EXC MAL LES TRUNK ARM LEGS 3.1-4,20001604,CDM,510,RC,,,outpatient,,,343,171.5,,332.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,205.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,294.66,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,308.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,308.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,205.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,249.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,234.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,205.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,276.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,276.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,303.93,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,227.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,277.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,315.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,325.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,332.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,222.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,205.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,308.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,205.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,205.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,308.7,
GS HBPC EXCISION MAL LES 0.6-1.0 CM FACE,20001641,CDM,510,RC,,,outpatient,,,176,88,,170.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.29,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.06,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,120.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,116.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,142.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,161.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,167.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,170.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,105.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,158.4,
PSN ASF CPS 12MM VE R 6-9 CD,20001672,CDM,278,RC,,,outpatient,,,2387,1193.5,,2315.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2148.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,2148.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1736.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1629.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1926.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1926.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2115.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1582.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1933.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,2196.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,2267.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,2315.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,1551.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2148.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,1432.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2148.3,
CER  OPTION TYPE 1 TPR SLEVE 0MM,20001677,CDM,278,RC,,,outpatient,,,217,108.5,,210.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,130.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3918.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,195.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,195.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.89,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,148.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,130.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,175.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,175.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,192.28,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,143.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,175.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,199.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,206.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,210.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,141.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,130.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,195.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,130.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,195.3,
PSN FEM PS CMT CCR NRW SZ7,20001681,CDM,278,RC,,,outpatient,,,4492,2246,,4357.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1347.6,30,,,percent of total billed charges,Pays at 30% of total billed charges,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3268.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,3065.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3625.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3625.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3980.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2978.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3638.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,4132.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,4267.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,4357.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,2919.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4042.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,2695.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,4042.8,
GS HBPC EXC TUMOR SOFT TIS ABD WALL <3 C,20002902,CDM,510,RC,,,outpatient,,,346.5,173.25,,336.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,207.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,426.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,311.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,311.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,236.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,207.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,279.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,279.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,307.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,229.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,280.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,318.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,329.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,336.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,225.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,207.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,311.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,207.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,311.85,
Complete bilateral study of the extremities,20003970,CDM,921,RC,,,outpatient,,,1140.75,570.38,,1106.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,684.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1026.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1026.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,1026.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,684.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,830.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,778.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,684.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,920.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,920.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1010.82,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,756.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,924.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1049.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,1083.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,1106.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,741.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,684.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,684.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,684.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1026.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,684.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,684.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1026.68,
S1 HBPC INC THROMBOSED HEMORRHOID EXTERN,20006083,CDM,510,RC,,,outpatient,,,117.25,58.63,,113.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,105.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,80.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,107.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,111.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,105.53,
GS HBPC HEMORRHOID LIGATION,20006221,CDM,510,RC,,,outpatient,,,154.5,77.25,,149.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,92.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.68,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,139.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,105.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,92.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,124.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,102.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,125.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,142.14,92,,,percent of total billed charges,Pays at 92% of total billed charges,146.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,149.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,92.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,92.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,139.05,
GS HBPC INCISION DRAIGE VULVA PERINEAL,20006405,CDM,510,RC,,,outpatient,,,37.5,18.75,,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,34.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,102.86,
GS HBPC SPIDER VEIN 1/2 HOUR,20006468,CDM,510,RC,,,outpatient,,,26.75,13.38,,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,102.86,
GS HBPC SCLEROTHERAPY SINGLE VEIN,20006470,CDM,510,RC,,,outpatient,,,155.25,77.63,,150.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,139.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,93.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,105.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,93.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,137.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,102.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,125.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,142.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,147.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,150.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,93.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,93.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,93.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,139.73,
Injections to remove spider veins on the limbs or trunk,20006471,CDM,510,RC,,,outpatient,,,517.5,258.75,,501.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,310.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,177.17,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,465.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,465.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,310.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,376.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,353.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,310.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,417.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,417.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,458.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,343.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,419.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,476.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,491.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,501.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,336.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,310.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,310.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,310.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,465.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,310.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,310.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,465.75,
Laser removal of incompetent vein,20006478,CDM,510,RC,,,outpatient,,,3302.75,1651.38,,3203.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,1981.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1013.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,2972.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,2972.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1981.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2403.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2254.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1981.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2665.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2665.98,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,2926.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2189.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,2675.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3038.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,3137.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,3203.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,2146.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,1981.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1981.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1981.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2972.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,1981.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1981.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,2972.48,
GS HBPC EVLT LASER SUBSEQ VEIN +,20006479,CDM,510,RC,,,outpatient,,,791.75,395.88,,768,97,,,percent of total billed charges,Pays at 97% of total billed charges,475.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,294.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,712.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,712.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,475.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,576.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,540.37,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,475.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,639.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,639.1,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,701.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,524.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,641.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,728.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,752.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,768,97,,,percent of total billed charges,Pays at 97% of total billed charges,514.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,475.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,475.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,475.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,712.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,475.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,475.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,712.58,
GS HBPC ENDOVENOUS ABLAT TX INCOMP EXT,20006482,CDM,510,RC,,,outpatient,,,7264.5,3632.25,,7046.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,4358.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1783.76,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,6538.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,6538.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,4358.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5285.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4958.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4358.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5863.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5863.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6437.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4816.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5884.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6683.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,6901.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,7046.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,4721.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,4358.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4358.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4358.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6538.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,4358.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,4358.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,6538.05,
GS HBPC ANOSCOPY,20006600,CDM,510,RC,,,outpatient,,,74.75,37.38,,72.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.5,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,49.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,60.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,68.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,72.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,102.86,
GS HBPC DESTRUCTION LESION ANUS SIMP SUR,20006922,CDM,510,RC,,,outpatient,,,405.25,202.63,,393.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,243.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,257.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,364.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,364.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,243.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,294.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,276.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,243.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,327.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,327.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,359.09,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,268.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,328.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,372.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,384.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,393.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,263.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,243.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,364.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,243.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,243.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,364.73,
US GS HBPC GUIDED NEEDLE PLACE LT,20006942,CDM,402,RC,,,outpatient,,,869,434.5,,842.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.2,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,782.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,782.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,632.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,593.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,701.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,701.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,770.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,576.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,703.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,799.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,825.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,842.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,564.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,782.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,782.1,
"Debridement (for example, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps)",20007597,CDM,510,RC,,,outpatient,,,48.75,24.38,,47.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.16,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,43.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,33.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,32.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,39.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,44.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,46.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,47.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,102.86,
GS HBPC DEBRIDE EPI/DERMIS EA ADD 20 SQC,20007598,CDM,510,RC,,,outpatient,,,55.25,27.63,,53.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.28,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,49.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,44.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,50.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,52.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,53.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.15,102.86,
GS HBPC NEG PRESSURE WOUND THERAPY <= 50,20007605,CDM,510,RC,,,outpatient,,,16.25,8.13,,15.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,102.86,
GS HBPC VASC SURG REMOVAL BLOOD CLOT,20007799,CDM,510,RC,,,outpatient,,,277.25,138.63,,268.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,166.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.18,30,,,percent of total billed charges,Pays at 30% of total billed charges,249.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,249.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,189.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,166.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,223.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,245.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,183.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,224.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,255.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,263.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,268.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,180.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,166.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,166.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,249.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,166.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,166.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,249.53,
TRANSTIBIAL ACL W/O SAWBLADE,20013798,CDM,272,RC,,,outpatient,,,346.5,173.25,,336.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,207.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,311.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,311.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,236.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,207.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,279.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,279.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,307.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,229.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,280.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,318.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,329.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,336.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,225.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,207.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,311.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,207.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,311.85,
MESH MARLEX MEDIUM,20052011,CDM,278,RC,,,outpatient,,,683.75,341.88,,663.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,410.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,615.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,615.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,410.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,497.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,466.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,410.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,551.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,551.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,605.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,453.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,553.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,629.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,649.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,663.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,444.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,410.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,410.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,410.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,615.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,410.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,410.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,615.38,
MESH VENTRALEX ST LG,20053323,CDM,278,RC,,,outpatient,,,1386,693,,1344.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,831.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,452.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1247.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,1247.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,831.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1008.45,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,945.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,831.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1118.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1118.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1228.13,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,918.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1122.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1275.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,1316.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,1344.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,900.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,831.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,831.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,831.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1247.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,831.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,831.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1247.4,
Limited ultrasound of the breast,20076642,CDM,402,RC,,,outpatient,,,213.25,106.63,,206.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,127.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.17,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,191.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,191.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,145.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,127.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,172.14,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,188.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,141.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,172.73,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,196.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,202.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,206.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,138.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,127.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,191.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,127.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,127.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,191.93,
Urine test,20088112,CDM,311,RC,,,outpatient,,,117.25,58.63,,113.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,105.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,80.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,107.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,111.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,105.53,
GS SURG PATH III,20088304,CDM,310,RC,,,outpatient,,,64,32,,62.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,51.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,58.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,60.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,62.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.4,102.86,
Test of tissues for diagnosis of abnormalities,20088305,CDM,310,RC,,,outpatient,,,202.75,101.38,,196.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,138.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,163.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,179.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,134.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,164.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,186.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,192.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,196.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,182.48,
Blood test to assist with diagnosis,20088312,CDM,310,RC,,,outpatient,,,144,72,,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,116.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,136.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,129.6,
GS IMMUNOCHEM  EA ADDT'L SINGLE,20088341,CDM,310,RC,,,outpatient,,,106.75,53.38,,103.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,72.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Pathology test,20088342,CDM,310,RC,,,outpatient,,,149.5,74.75,,145.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.55,
"GS MORPHOMETRIC ALYSIS, TUMOR",20088361,CDM,310,RC,,,outpatient,,,538.5,269.25,,522.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,323.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,484.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,484.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,323.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,391.81,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,367.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,323.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,434.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,434.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,477.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,357.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,436.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,495.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,511.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,522.35,97,,,percent of total billed charges,Pays at 97% of total billed charges,350.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,323.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,323.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,323.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,484.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,323.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,323.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,484.65,
DRILL BIT NON LOCKING,20098678,CDM,270,RC,,,outpatient,,,895.75,447.88,,868.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,537.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,268.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,806.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,806.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,537.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,651.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,611.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,537.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,723.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,723.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,793.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,593.88,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,725.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,824.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,850.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,868.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,582.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,537.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,537.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,537.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,806.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,537.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,537.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,806.18,
Outpatient visit of established patient not requiring a physician,20500001,CDM,510,RC,,,outpatient,,,26.75,13.38,,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,102.86,
Outpatient visit of established patient requiring a physician,20500002,CDM,510,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,102.86,
"Established patient office or other outpatient visit, typically 15 minutes",20500003,CDM,510,RC,,,outpatient,,,40.25,20.13,,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,102.86,
"Established patient office or other outpatient visit, typically 25 minutes",20500004,CDM,510,RC,,,outpatient,,,65.5,32.75,,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,53.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,60.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,62.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,102.86,
"Established patient office or other outpatient, visit typically 40 minutes",20500005,CDM,510,RC,,,outpatient,,,99,49.5,,96.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,80.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,91.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,94.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,96.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,102.86,
GS HBPC INCISION/DRAIN ABSCESS MULTIPLE,20500061,CDM,510,RC,,,outpatient,,,73,36.5,,70.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,65.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,49.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,48.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,59.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,67.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,69.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,70.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,43.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.8,102.86,
OS HBPC INCISION REMOVAL FB SUBC TISS CO,20500121,CDM,510,RC,,,outpatient,,,96,48,,93.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,255.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,86.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,65.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,63.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,77.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,88.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,91.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,93.12,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,57.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.6,102.86,
"Incision and draige of hematoma, seroma or fluid collection",20500140,CDM,510,RC,,,outpatient,,,80,40,,77.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.58,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,70.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,64.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,76,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52,65,,,percent of total billed charges,Pays at 65% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72,90,,,percent of total billed charges,Pays at 90% of total billed charges,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,48,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48,102.86,
OS HBPC CARPAL TUNNEL INJECTION,20500526,CDM,510,RC,,,outpatient,,,40.5,20.25,,39.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,36.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.3,102.86,
Injection of medication into a tendon or ligament,20500550,CDM,510,RC,,,outpatient,,,43.5,21.75,,42.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.1,102.86,
OS HBPC TRIGGER PT INJ MUSCLE 1-2,20500552,CDM,510,RC,,,outpatient,,,36.5,18.25,,35.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.94,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,29.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,33.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,34.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,35.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,21.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.9,102.86,
Injection of medication into an area that triggers pain,20500553,CDM,510,RC,,,outpatient,,,41.75,20.88,,40.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,28.49,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,38.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,39.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,40.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,25.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.05,102.86,
Draining or injecting medication into a small joint/bursa without ultrasound,20500600,CDM,510,RC,,,outpatient,,,26.25,13.13,,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,102.86,
Draining or injecting medication into a large joint/bursa without ultrasound,20500605,CDM,510,RC,,,outpatient,,,47,23.5,,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,38.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,43.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,102.86,
Draining or injecting medication into a major joint/bursa without ultrasound,20500610,CDM,510,RC,,,outpatient,,,77.5,38.75,,75.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.61,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,69.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,51.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,62.78,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,71.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,73.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,75.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,46.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.5,102.86,
OS HBPC DEBRIDE OPEN FX SKIN SUBCUTANEOU,20501010,CDM,510,RC,,,outpatient,,,640.5,320.25,,621.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,384.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,450.78,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,576.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,576.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,384.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,466.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,437.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,384.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,517.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,517.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,567.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,424.65,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,518.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,589.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,608.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,621.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,416.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,384.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,384.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,384.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,576.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,384.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,384.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,576.45,
Separation and removal of the entire il plate or a portion of il plate,20501730,CDM,510,RC,,,outpatient,,,89.5,44.75,,86.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,80.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,53.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,72.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,82.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,85.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,86.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,53.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,53.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.7,102.86,
OS HBPC REPAIR OF IL BED,20501760,CDM,510,RC,,,outpatient,,,305,152.5,,295.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,183,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,179.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,274.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,274.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,183,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,208.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,183,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,246.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,246.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,270.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,202.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,247.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,280.6,92,,,percent of total billed charges,Pays at 92% of total billed charges,289.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,295.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,198.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,183,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,274.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,183,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,183,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,274.5,
OS HBPC CLOSED TX CLAVICLE FX W/O MANIP,20503500,CDM,510,RC,,,outpatient,,,16.75,8.38,,16.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,15.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.05,102.86,
OS HBPC CLOSED TX ACROMIOCLAV DISL WO MA,20503540,CDM,510,RC,,,outpatient,,,15.75,7.88,,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,216.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,10.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,12.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,12.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,14.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,9.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.45,102.86,
OS HBPC CLOSED TX SCAPULAR FX W/O MANIP,20503570,CDM,510,RC,,,outpatient,,,16.75,8.38,,16.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,15.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.05,102.86,
OS HBPC CL TX PROX HUMERUS FX W/O MANIP,20503600,CDM,510,RC,,,outpatient,,,89.25,44.63,,86.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,307.13,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,80.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,72.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,82.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,84.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,86.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.55,102.86,
OS HBPC CLOSED TX GREATER HUM TUB W/O MA,20503620,CDM,510,RC,,,outpatient,,,53.5,26.75,,51.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,48.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,32.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,47.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,43.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,49.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.9,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,32.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,32.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.1,102.86,
OS HBPC CLOSED TX HUMERAL SHAFT FX W/O M,20504500,CDM,510,RC,,,outpatient,,,119.25,59.63,,115.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,309.68,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,107.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,81.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,96.59,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,109.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,113.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,115.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,71.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,107.33,
OS HBPC CL TX SUPRACONDYLAR TRANS HUM FX,20504530,CDM,510,RC,,,outpatient,,,124.75,62.38,,121.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,357.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,85.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,82.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,101.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,114.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,118.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,121.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,112.28,
OS HBPC CL TX HUMERAL EPICONDYLAR FX W/O,20504560,CDM,510,RC,,,outpatient,,,124.75,62.38,,121.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,303.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,85.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.7,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,82.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,101.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,114.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,118.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,121.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,74.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,112.28,
OS HBPC CLOSED TX HUMERAL CONDYLAR FX,20504576,CDM,510,RC,,,outpatient,,,114,57,,110.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.3,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,102.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,102.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,75.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,92.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,104.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,108.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,110.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
OS HBPC CL TX RADIUS HEAD/NECK FX W/O MA,20504650,CDM,510,RC,,,outpatient,,,89.25,44.63,,86.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,243.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,80.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,72.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,82.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,84.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,86.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.55,102.86,
OS HBPC CL TX ULR FX PROX ENDW/O MANIP,20504670,CDM,510,RC,,,outpatient,,,106.25,53.13,,103.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,271.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,95.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,72.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,97.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,100.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,63.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
OS HBPC CLSD TX ULR SHAFT FX W/O MANIP,20505530,CDM,510,RC,,,outpatient,,,92.5,46.25,,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,74.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,102.86,
OS HBPC CL TX DIS RAD FX W/W/O UL W/OM,20505600,CDM,510,RC,,,outpatient,,,102,51,,98.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,291.77,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,91.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,82.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,93.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
OS HBPC CLOSED TX DISTAL RADIAL FX W MAN,20505605,CDM,510,RC,,,outpatient,,,122.75,61.38,,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,489.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,99.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,112.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,119.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,73.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,110.48,
OS HBPC CL TX CARPAL SCAPHOID FX W/O MAN,20505622,CDM,510,RC,,,outpatient,,,101.5,50.75,,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,284.71,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,82.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,93.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
OS HBPC CLOSED TX CARPAL BONE FX W/O MAN,20505630,CDM,510,RC,,,outpatient,,,106.25,53.13,,103.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,286.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,95.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,72.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,97.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,100.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,63.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
OS HBPC CLOSED TX METACARPAL FX W/O MANI,20506600,CDM,510,RC,,,outpatient,,,75.25,37.63,,72.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,273.75,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,67.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.36,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,49.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,60.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,69.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,72.99,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.15,102.86,
OS HBPC CLOSED FX METACARPAL SING W MANI,20506605,CDM,510,RC,,,outpatient,,,100.25,50.13,,97.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,303.2,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,90.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,68.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,66.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,81.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,92.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,95.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,97.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
OS HBPC CL TX PHALANX SHAFT FX FING W/O,20506720,CDM,510,RC,,,outpatient,,,61,30.5,,59.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,183.18,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,54.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.38,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,41.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,36.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,40.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,49.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,56.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,57.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,59.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,36.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,36.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.6,102.86,
OS HBPC CLOSED TX PHALANX SHAFT FX W/MAN,20506725,CDM,510,RC,,,outpatient,,,123,61.5,,119.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,318.96,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,110.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,110.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,83.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,73.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,81.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,99.63,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,113.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,116.85,95,,,percent of total billed charges,Pays at 95% of total billed charges,119.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.95,65,,,percent of total billed charges,Pays at 65% of total billed charges,73.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,73.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,110.7,
OS HBPC CLOSED TX ARTICULAR FX W/O MANIP,20506740,CDM,510,RC,,,outpatient,,,51.5,25.75,,49.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,214.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,46.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,35.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,41.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,47.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,48.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,49.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.9,102.86,
OS HBPC CL TX DISTAL PHALANX FX W/O MANI,20506750,CDM,510,RC,,,outpatient,,,17.25,8.63,,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.09,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,102.86,
OS HBPC CLSD TRT INTERPHAL JT DISLOCATIO,20506770,CDM,510,RC,,,outpatient,,,50.25,25.13,,48.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.9,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,45.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,40.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,46.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,47.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,48.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,102.86,
OS HBPC CL TX ACETABULUM FX W/O MANIP,20507220,CDM,510,RC,,,outpatient,,,16.25,8.13,,15.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,518.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,10.77,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,14.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,15.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,9.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.75,102.86,
OS HBPC CLOSED TX SUPRAC FEM FX W/O MANI,20507501,CDM,510,RC,,,outpatient,,,26,13,,25.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,491.15,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,23.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.6,102.86,
OS HBPC CLOSED TX FEMORAL FX W/O MANIP,20507508,CDM,510,RC,,,outpatient,,,106.5,53.25,,103.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,503.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,95.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,72.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.97,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,97.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,63.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
OS HBPC CLOSED TX PATELLAR FX W/O MANIP,20507520,CDM,510,RC,,,outpatient,,,109.5,54.75,,106.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,279.95,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,98.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,98.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,74.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,65.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.39,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,72.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,88.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,100.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,104.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,106.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,65.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,65.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
OS HBPC CL TX TIBIAL FX PROX W/O MANIP,20507530,CDM,510,RC,,,outpatient,,,100.25,50.13,,97.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,282.19,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,90.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,68.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,80.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,66.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,81.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,92.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,95.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,97.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,60.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
OS HBPC CL TX TIBIAL SHAFT FX W/O MANIP,20507750,CDM,510,RC,,,outpatient,,,102,51,,98.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,325.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,91.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,82.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,93.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
OS HBPC CLOSED TX MEDIAL MALLEOLUS FX,20507760,CDM,510,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,311.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
OS HBPC CLOSED TX POST MALLEOLUS FX,20507767,CDM,510,RC,,,outpatient,,,102,51,,98.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,264.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,91.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,82.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,93.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
OS HBPC CLOSED TX PROX FIBULA FX W/O MAN,20507780,CDM,510,RC,,,outpatient,,,102,51,,98.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,285.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,91.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,82.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,93.84,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,61.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
OS HBPC CLOSED TX DIST FIB FX W/O MANIP,20507786,CDM,510,RC,,,outpatient,,,113.5,56.75,,110.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,294.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,102.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,102.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,91.62,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,75.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,104.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,107.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,110.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,68.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
OS HBPC CL TX FX BIMALLEOLAR ANKLE W/O M,20507808,CDM,510,RC,,,outpatient,,,125.5,62.75,,121.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,311.97,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,112.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,85.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,75.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,111.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,83.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,101.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,115.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,119.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,121.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,81.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,75.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,75.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,112.95,
OS HBPC CL TX FX DISTAL TIBIA W/O MANIP,20507824,CDM,510,RC,,,outpatient,,,40.75,20.38,,39.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,298.73,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,27.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,33.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,24.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.45,102.86,
OS HBPC CL TX CALCANEAL FX W/O MANIP,20508400,CDM,510,RC,,,outpatient,,,71.75,35.88,,69.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,231.69,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.58,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,47.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,58.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,66.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,68.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,69.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,43.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.05,102.86,
OS HBPC CL TX TALUS FX W/O MANIP,20508430,CDM,510,RC,,,outpatient,,,92.5,46.25,,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.45,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,74.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,102.86,
OS HBPC TX TARSAL FX WO MANIP EACH,20508450,CDM,510,RC,,,outpatient,,,81.25,40.63,,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,198.77,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,55.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,65.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,74.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,77.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,102.86,
OS HBPC CLD TX METATARSAL FX WO MANIP EA,20508470,CDM,510,RC,,,outpatient,,,77.75,38.88,,75.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,204.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,69.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,53.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,46.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.76,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,51.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,62.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,71.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,73.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,75.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,46.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,46.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.65,102.86,
OS HBPC CLOSED TX FX GREAT TOE PHAL W/O,20508490,CDM,510,RC,,,outpatient,,,62.75,31.38,,60.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.94,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,56.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,42.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.6,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,50.83,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,57.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,59.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,60.87,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,37.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.65,102.86,
OS HBPC CLD TX FX PHAL TOE WO MANIP EACH,20508510,CDM,510,RC,,,outpatient,,,16.75,8.38,,16.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,15.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,15.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,10.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.05,102.86,
OS HBPC APPLICATION SHORT ARM SPLINT STA,20509125,CDM,510,RC,,,outpatient,,,85.25,42.63,,82.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,76.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,80.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,82.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,51.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.15,102.86,
Draining or injecting medication into a small joint/bursa without ultrasound,20595600,CDM,510,RC,,,outpatient,,,52.5,26.25,,50.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,35.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,49.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,50.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.5,102.86,
Outpatient visit of established patient not requiring a physician,20700001,CDM,510,RC,,,outpatient,,,26.75,13.38,,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,102.86,
Outpatient visit of established patient requiring a physician,20700002,CDM,510,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,102.86,
"Established patient office or other outpatient visit, typically 15 minutes",20700003,CDM,510,RC,,,outpatient,,,40.25,20.13,,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,102.86,
"Established patient office or other outpatient visit, typically 25 minutes",20700004,CDM,510,RC,,,outpatient,,,65.5,32.75,,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,53.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,60.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,62.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,102.86,
"Established patient office or other outpatient, visit typically 40 minutes",20700005,CDM,510,RC,,,outpatient,,,99,49.5,,96.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,80.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,91.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,94.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,96.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,102.86,
Fine Needle Aspiration Biopsy without imaging,20700021,CDM,510,RC,,,outpatient,,,166.25,83.13,,161.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.52,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,149.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,134.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,152.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,157.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,161.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,149.63,
S1 HBPC TRIM TOE ILS,20700027,CDM,510,RC,,,outpatient,,,32.75,16.38,,31.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.67,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,31.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,90,
Incision and draige of abscess; simple or single and complex or multiple,20700060,CDM,510,RC,,,outpatient,,,37.5,18.75,,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.18,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,34.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,102.86,
"Tangential biopsy of skin (e.g., for example, shave, scoop, saucerize, curette); single lesion",20700102,CDM,510,RC,,,outpatient,,,224.25,112.13,,217.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,134.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.48,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,201.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,201.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,153.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,134.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,181.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,198.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,148.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,181.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,206.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,213.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,217.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,145.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,134.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,134.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,201.83,
S1 HBPC INCISION REMOVAL FB SIMPLE,20700120,CDM,510,RC,,,outpatient,,,160.5,80.25,,155.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,144.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,144.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,109.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,96.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,129.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,142.22,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,106.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,130.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,147.66,92,,,percent of total billed charges,Pays at 92% of total billed charges,152.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,155.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,96.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,144.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,96.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,144.45,
"Incision and draige of hematoma, seroma or fluid collection",20700140,CDM,510,RC,,,outpatient,,,80.25,40.13,,77.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,72.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,76.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,48.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,48.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.15,102.86,
"Puncture aspiration of abscess, hematoma, bulla, or cyst",20700160,CDM,510,RC,,,outpatient,,,68.25,34.13,,66.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,45.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,55.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,62.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,66.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,102.86,
S1 HBPC NEG PRESS WOUND THER NO SUP >50,20700606,CDM,510,RC,,,outpatient,,,47.75,23.88,,46.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.55,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,42.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,38.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,43.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,45.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,46.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.65,102.86,
S1 HBPC DEBRIDEMENT SKIN SUBCUTAN TISSUE,20701042,CDM,510,RC,,,outpatient,,,63.5,31.75,,61.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.69,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,57.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,51.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,58.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,60.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,61.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,38.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.1,102.86,
S1 HBPC DEBRIDEMENT MUSCLE FASCIA 20 SQC,20701043,CDM,510,RC,,,outpatient,,,132,66,,128.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,218.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,118.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,118.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,90.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,87.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,106.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,121.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,125.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,128.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,79.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,118.8,
S1 HBPC DEBRIDEMENT BONE 1ST 20 SQ CM,20701044,CDM,510,RC,,,outpatient,,,166.75,83.38,,161.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,300.77,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.33,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,135.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,153.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,158.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,161.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,100.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,150.08,
S1 HBPC DEBRIDEMENT SUBCU TIS ADDTL 20 S,20701045,CDM,510,RC,,,outpatient,,,28.25,14.13,,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.77,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,102.86,
S1 HBPC PARING CUTTING BEN HYPERKERATOTI,20701055,CDM,510,RC,,,outpatient,,,59.25,29.63,,57.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.2,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,53.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,40.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,47.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,39.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,47.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,54.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,56.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,57.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,35.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.55,102.86,
Paring or cutting of benign hyperkeratotic lesion,20701056,CDM,510,RC,,,outpatient,,,62,31,,60.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.5,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,42.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,50.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,57.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,58.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,60.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.2,102.86,
S1 HBPC PUNCH BX SKIN SINGLE LESION,20701104,CDM,510,RC,,,outpatient,,,287.5,143.75,,278.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,258.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,258.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,196.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,232.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,254.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,190.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,232.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,264.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,273.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,278.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,186.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,258.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,258.75,
S1 HBPC PUNCH BX SKIN EACH ADDTL LESION,20701105,CDM,510,RC,,,outpatient,,,127.25,63.63,,123.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.57,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,114.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,86.85,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,112.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,84.37,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,103.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,117.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,120.89,95,,,percent of total billed charges,Pays at 95% of total billed charges,123.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.71,65,,,percent of total billed charges,Pays at 65% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,76.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,114.53,
"Removal of skin tags, multiple fibrocutaneous tags, any area",20701200,CDM,510,RC,,,outpatient,,,31,15.5,,30.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.66,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,102.86,
S1 HBPC SHAVE EPID DERM LES SING <0.5 CM,20701305,CDM,510,RC,,,outpatient,,,73.75,36.88,,71.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.9,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,66.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,66.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,50.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,44.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,59.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.35,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,48.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,59.74,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,67.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,70.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,71.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,44.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,44.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.25,102.86,
S1 HBPC SHAVING EPIDERMAL/DERMAL LESION,20701306,CDM,510,RC,,,outpatient,,,91.75,45.88,,89,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.98,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,82.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.76,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,62.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.3,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,60.83,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,74.32,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,84.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,89,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,55.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.05,102.86,
S1 HBPC SHAVE EPIDER DERM LES 1.1 TO 2.0,20701307,CDM,510,RC,,,outpatient,,,37.5,18.75,,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.5,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,34.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,102.86,
S1 HBPC SHAVING EPIDER DERMAL LESION SCA,20701308,CDM,510,RC,,,outpatient,,,98.75,49.38,,95.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,88.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,59.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,79.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,90.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,93.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,95.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,59.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,59.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.25,102.86,
S1 HBPC EXCISION BEN LESION 0.5 CM OR <,20701400,CDM,510,RC,,,outpatient,,,95,47.5,,92.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,85.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,64.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.18,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,62.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,76.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,87.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,90.25,95,,,percent of total billed charges,Pays at 95% of total billed charges,92.15,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.75,65,,,percent of total billed charges,Pays at 65% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,57,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57,102.86,
Under Excision-Benign Lesions Procedures on the Skin 0.6-1 CM,20701401,CDM,510,RC,,,outpatient,,,102.5,51.25,,99.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,92.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,92.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,61.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.74,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,83.03,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,94.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,97.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,99.43,97,,,percent of total billed charges,Pays at 97% of total billed charges,66.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,61.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,61.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
S1 HBPC EXCISION BENIGN LES 1.1-2.0 CM,20701402,CDM,510,RC,,,outpatient,,,115.75,57.88,,112.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.57,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,104.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,93.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,102.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,76.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,93.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,106.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,109.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,112.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,104.18,
Under Excision-Benign Lesions Procedures on the Skin 1.1-2 CM,20701422,CDM,510,RC,,,outpatient,,,88.25,44.13,,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.52,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,81.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,102.86,
S1 HBPC EXCISION MALIG 0.6-1.0 CM SCALP,20701621,CDM,510,RC,,,outpatient,,,174.25,87.13,,169.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,213.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,156.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,156.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,118.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,140.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,140.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,154.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,115.53,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,141.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,160.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,165.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,169.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,156.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,104.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,156.83,
S1 HBPC EXC MALG LES <=0.5 LESS FACE,20701640,CDM,510,RC,,,outpatient,,,284,142,,275.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,170.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,255.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,255.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,170.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,193.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,170.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,229.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,229.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,251.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,188.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,230.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,261.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,269.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,275.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,184.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,170.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,255.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,170.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,170.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,255.6,
S1 HBPC TRIMMING NONDYSTROPHIC ILS ANY,20701719,CDM,510,RC,,,outpatient,,,18,9,,17.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.83,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.53,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,14.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,16.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,10.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.8,102.86,
S1 HBPC DEBRIDEMENT IL 1-5,20701720,CDM,510,RC,,,outpatient,,,51.5,25.75,,49.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,46.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,35.15,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.63,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,41.72,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,47.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,48.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,49.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,30.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.9,102.86,
Separation and removal of the entire il plate or a portion of il plate,20701730,CDM,510,RC,,,outpatient,,,89.5,44.75,,86.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,80.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,53.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,72.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,82.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,85.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,86.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,53.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,53.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.7,102.86,
S1 HBPC EXCISION IL/MATRIX PART/COMPLE,20701750,CDM,510,RC,,,outpatient,,,128.5,64.25,,124.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.25,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,87.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,85.2,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,104.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,118.22,92,,,percent of total billed charges,Pays at 92% of total billed charges,122.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,124.65,97,,,percent of total billed charges,Pays at 97% of total billed charges,83.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,77.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,115.65,
S1 HBPC EXCISION PILONIDAL CYST/SINUS SI,20701770,CDM,510,RC,,,outpatient,,,289.75,144.88,,281.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,173.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,267.29,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,260.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,260.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,173.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,210.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,197.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,173.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,233.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,233.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,256.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,192.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,234.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,266.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,275.26,95,,,percent of total billed charges,Pays at 95% of total billed charges,281.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,188.34,65,,,percent of total billed charges,Pays at 65% of total billed charges,173.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,260.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,173.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,173.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,260.78,
"Simple repair of superficial wounds of scalp, neck, axillae, exterl genitalia, trunk and/or extremities",20702001,CDM,510,RC,,,outpatient,,,114.25,57.13,,110.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,102.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,102.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.98,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,75.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,92.54,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,105.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,108.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,110.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,68.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
S1 HBPC TX SUPERFIC WOUND DEHIS PACKING,20702021,CDM,510,RC,,,outpatient,,,47,23.5,,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,38.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,43.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,102.86,
S1 HBPC LAYERED CLOSURE WOUND <2.5 CM,20702031,CDM,510,RC,,,outpatient,,,187.5,93.75,,181.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.18,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,168.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,127.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,151.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,166.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,124.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,151.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,172.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,178.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,181.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,168.75,
S1 HBPC APPLICATION SKIN SUB GRAFT TRUNK,20705271,CDM,510,RC,,,outpatient,,,165.5,82.75,,160.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.14,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,148.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,148.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.42,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,112.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,99.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,133.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,146.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,109.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,134.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,152.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,157.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,160.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,107.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,99.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,99.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,148.95,
S1 HBPC APPLICATION SKIN SUB GRAFT ADDTL,20705272,CDM,510,RC,,,outpatient,,,27.5,13.75,,26.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.45,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,102.86,
S1 HBPC APPLICATION SKIN SUB GRAFT FIRST,20705275,CDM,510,RC,,,outpatient,,,155.25,77.63,,150.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.97,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,139.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,139.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,93.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,105.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,93.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,125.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,125.32,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,137.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,102.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,125.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,142.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,147.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,150.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,100.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,93.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,93.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,93.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,93.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,139.73,
S1 HBPC DRESS DEBRIDE PART THICK BURN SM,20706020,CDM,510,RC,,,outpatient,,,39.25,19.63,,38.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,35.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,31.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,36.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,37.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,38.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.55,102.86,
S1 HBPC INC THROMBOSED HEMORRHOID EXTERN,20706083,CDM,510,RC,,,outpatient,,,117.25,58.63,,113.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,105.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,80.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,107.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,111.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,105.53,
S1 HBPC HEMORRHOIDECTOMY INTERL RUBBER,20706221,CDM,510,RC,,,outpatient,,,140.5,70.25,,136.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.68,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,126.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,126.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.23,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,124.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,113.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,133.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,136.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,84.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,126.45,
S1 HBPC ANOSCOPY,20706600,CDM,510,RC,,,outpatient,,,76.25,38.13,,73.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.5,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,73.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.75,102.86,
S1 HBPC CLSD TRT INTERPHAL JT DISLOCATIO,20706770,CDM,510,RC,,,outpatient,,,50.25,25.13,,48.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,262.9,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,45.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,34.3,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.53,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,33.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,40.7,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,46.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,47.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,48.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,30.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,102.86,
Destruction of 1-14 common or plantar warts,20707110,CDM,510,RC,,,outpatient,,,95.5,47.75,,92.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,85.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,65.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,63.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,77.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,87.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,90.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,92.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.3,102.86,
Chemical destruction of pre-cancerous lesions of the skin,20707250,CDM,510,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
"Debridement (for example, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps)",20707597,CDM,510,RC,,,outpatient,,,48.75,24.38,,47.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.16,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,43.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,33.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,32.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,39.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,44.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,46.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,47.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,102.86,
S1 HBPC DEBRIDE EPI/DERMIS EA ADD 20 SQC,20707598,CDM,510,RC,,,outpatient,,,55.25,27.63,,53.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.28,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,49.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.71,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,44.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,36.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,44.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,50.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,52.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,53.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,33.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.15,102.86,
S1 HBPC NEG PRESSURE WOUND THERAPY <= 50,20707602,CDM,510,RC,,,outpatient,,,17.25,8.63,,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,102.86,
S1 HBPC NEG PRESSURE WOUND THERAPY <= 50,20707605,CDM,510,RC,,,outpatient,,,17.25,8.63,,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,102.86,
S1 HBPC WOUND VAC OVER 50 SQ CM,20707606,CDM,510,RC,,,outpatient,,,27.5,13.75,,26.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.55,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,102.86,
S1 HBPC NEG PRESSURE SP THER <=50 SQCM,20707607,CDM,510,RC,,,outpatient,,,322,161,,312.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,193.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,289.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,289.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,193.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,234.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,219.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,193.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,259.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,259.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,285.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,213.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,260.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,296.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,305.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,312.34,97,,,percent of total billed charges,Pays at 97% of total billed charges,209.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,193.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,193.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,289.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,193.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,193.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,289.8,
S1 HBPC DRAIN EXT EAR ABSCESS HEMATOMA S,20709000,CDM,510,RC,,,outpatient,,,142.25,71.13,,137.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.64,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,128.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,97.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,94.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,115.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,130.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,135.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,92.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,128.03,
S1 HBPC APPLICATION SHORT ARM SPLINT STA,20709125,CDM,510,RC,,,outpatient,,,85.25,42.63,,82.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,76.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.54,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.52,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,80.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,82.69,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,51.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.15,102.86,
S1 HBPC REMOVAL IMPACTED CERUM IRRG/LAVA,20709209,CDM,510,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,102.86,
S1 HBPC APPLICATION RIGID TCC LEG CAST,20709445,CDM,510,RC,,,outpatient,,,70.25,35.13,,68.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.99,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,47.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.71,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,56.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,64.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,66.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,68.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,42.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.15,102.86,
S1 HBPC STRAPPING U BOOT,20709580,CDM,510,RC,,,outpatient,,,34.5,17.25,,33.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.95,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,31.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,32.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,20.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.7,102.86,
S1 KOH PREP SKIN HAIR ILS,20787220,CDM,300,RC,,,outpatient,,,42.5,21.25,,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.71,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.76,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,39.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,102.86,
Blood test to assist with diagnosis,20788313,CDM,310,RC,,,outpatient,,,89.25,44.63,,86.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.6,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,80.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.91,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,72.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,82.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,84.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,86.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,53.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.55,102.86,
S1 IMMUNOHISTOCHEM EA ADDT'L SINGLE,20788341,CDM,310,RC,,,outpatient,,,106.75,53.38,,103.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,72.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Pathology test,20788342,CDM,310,RC,,,outpatient,,,149.5,74.75,,145.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.55,
Immunization administration by a medical assistant or nurse,20790471,CDM,771,RC,,,outpatient,,,28.25,14.13,,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,102.86,
GS THER INJ SQ OR IM,20796372,CDM,510,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
Outpatient visit of established patient not requiring a physician,20900001,CDM,510,RC,,,outpatient,,,26.75,13.38,,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,102.86,
Outpatient visit of established patient requiring a physician,20900002,CDM,510,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,102.86,
"Established patient office or other outpatient visit, typically 15 minutes",20900003,CDM,510,RC,,,outpatient,,,40.25,20.13,,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,102.86,
"Established patient office or other outpatient visit, typically 25 minutes",20900004,CDM,510,RC,,,outpatient,,,65.5,32.75,,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,53.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,60.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,62.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,102.86,
"Established patient office or other outpatient, visit typically 40 minutes",20900005,CDM,510,RC,,,outpatient,,,99,49.5,,96.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,80.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,91.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,94.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,96.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,102.86,
Fine Needle Aspiration Biopsy without imaging,20900021,CDM,510,RC,,,outpatient,,,166.25,83.13,,161.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.52,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,149.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,134.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,152.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,157.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,161.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,149.63,
Incision and draige of abscess; simple or single and complex or multiple,20900060,CDM,510,RC,,,outpatient,,,37.5,18.75,,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.18,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,34.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,102.86,
SG HBPC INCISION/DRAIGE ABSCESS COMPLI,20900061,CDM,510,RC,,,outpatient,,,75.5,37.75,,73.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,69.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,73.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.3,102.86,
SG HBPC INCISION DRAIGE PILONIDAL CYST,20900080,CDM,510,RC,,,outpatient,,,112.25,56.13,,108.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.1,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,101.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,103.27,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.64,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.96,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Incision and draige of hematoma, seroma or fluid collection",20900140,CDM,510,RC,,,outpatient,,,80.25,40.13,,77.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,72.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,54.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,73.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,76.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,77.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,48.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,48.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.15,102.86,
"Puncture aspiration of abscess, hematoma, bulla, or cyst",20900160,CDM,510,RC,,,outpatient,,,68.25,34.13,,66.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,45.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,55.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,62.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,66.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,102.86,
SG HBPC CARPAL TUNNEL INJECTION,20900526,CDM,510,RC,,,outpatient,,,40.5,20.25,,39.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,36.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,24.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.3,102.86,
Injection of medication into a tendon or ligament,20900550,CDM,510,RC,,,outpatient,,,27.75,13.88,,26.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.4,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.65,102.86,
Draining or injecting medication into a small joint/bursa without ultrasound,20900600,CDM,510,RC,,,outpatient,,,26.25,13.13,,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,102.86,
Draining or injecting medication into a large joint/bursa without ultrasound,20900605,CDM,510,RC,,,outpatient,,,47,23.5,,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.08,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,41.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,38.07,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,43.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,44.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,45.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,28.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.2,102.86,
SG HBPC ARTHROCENTESIS ASP/INJ INTERM JT,20900611,CDM,510,RC,,,outpatient,,,54.25,27.13,,52.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,48.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,37.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.79,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.07,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,43.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,49.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,51.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,52.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,35.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,32.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.55,102.86,
Removal of fluid or injection of medication into a ganglion cyst,20900612,CDM,510,RC,,,outpatient,,,86,43,,83.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.69,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,77.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,57.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,79.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,51.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.6,102.86,
SG HBPC DEBRIDEMENT SKIN SUBCUTAN TISSUE,20901042,CDM,510,RC,,,outpatient,,,63.5,31.75,,61.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.69,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,57.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,51.44,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,58.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,60.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,61.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,38.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.1,102.86,
SG HBPC PUNCH BX SKIN SINGLE LESION,20901104,CDM,510,RC,,,outpatient,,,287.5,143.75,,278.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,258.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,258.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,196.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,232.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,254.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,190.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,232.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,264.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,273.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,278.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,186.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,258.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,258.75,
"Removal of skin tags, multiple fibrocutaneous tags, any area",20901200,CDM,510,RC,,,outpatient,,,31,15.5,,30.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.66,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,102.86,
SG HBPC REMOVAL SKIN TAGS EA ADDTL 10 OR,20901201,CDM,510,RC,,,outpatient,,,3.75,1.88,,3.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,2.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.03,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,3.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,2.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,3.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,3.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,3.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,2.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.25,102.86,
SG HBPC EXCISION BEN LES 0.5 OR < CM TRU,20901400,CDM,510,RC,,,outpatient,,,98,49,,95.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,88.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,88.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,66.89,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,58.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,64.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,79.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,90.16,92,,,percent of total billed charges,Pays at 92% of total billed charges,93.1,95,,,percent of total billed charges,Pays at 95% of total billed charges,95.06,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.7,65,,,percent of total billed charges,Pays at 65% of total billed charges,58.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.2,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,58.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.8,102.86,
Under Excision-Benign Lesions Procedures on the Skin 0.6-1 CM,20901401,CDM,510,RC,,,outpatient,,,101.25,50.63,,98.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,91.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,82.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,93.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
SG HBPC EXCISION BEN LES 1.1-2.0 CM TRUN,20901402,CDM,510,RC,,,outpatient,,,112.5,56.25,,109.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.57,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,101.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,103.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,109.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
SG HBPC EXCISION BENIGN <.5 CM,20901420,CDM,510,RC,,,outpatient,,,80.75,40.38,,78.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.75,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,72.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.75,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,55.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,65.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,74.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,76.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,78.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,48.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.45,102.86,
SG HBPC EXCISION BENIGN LES 0.6-1.0 CM S,20901421,CDM,510,RC,,,outpatient,,,94.25,47.13,,91.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,84.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,64.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.08,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,62.49,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,76.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,86.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,89.54,95,,,percent of total billed charges,Pays at 95% of total billed charges,91.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.26,65,,,percent of total billed charges,Pays at 65% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,56.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.55,102.86,
Under Excision-Benign Lesions Procedures on the Skin 1.1-2 CM,20901422,CDM,510,RC,,,outpatient,,,88.25,44.13,,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,165.52,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,81.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,102.86,
SG HBPC EXCISION BENIGN LES FACE/EAR/EYE,20901440,CDM,510,RC,,,outpatient,,,74.75,37.38,,72.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.34,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,66.24,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,49.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,60.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,68.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,71.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,72.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,44.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.85,102.86,
SG HBPC REMOVAL NONBIODEGRAD DRUG DELIV,20901982,CDM,510,RC,,,outpatient,,,120.75,60.38,,117.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,108.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,111.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,117.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,72.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.68,
SG HBPC THORACENT NEEDLE CATH ASP PLEU W,20902554,CDM,510,RC,,,outpatient,,,2124.5,1062.25,,2060.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,1274.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1912.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1912.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1274.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1545.79,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1449.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1274.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1714.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1714.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1882.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1408.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1720.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1954.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,2018.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,2060.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,1380.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,1274.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1274.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1274.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1912.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,1274.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1274.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1912.05,
SG HBPC REPLACEMENT GASTROSTOMY TUBE,20903762,CDM,510,RC,,,outpatient,,,533.25,266.63,,517.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,319.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,196.48,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,479.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,479.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,319.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,387.99,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,363.94,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,319.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,430.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,430.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,472.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,353.54,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,431.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,490.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,506.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,517.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,346.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,319.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,319.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,319.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,479.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,319.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,319.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,479.93,
SG HBPC INJ ANES AGT PERIPH NERVE,20904450,CDM,510,RC,,,outpatient,,,144.5,72.25,,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.16,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.14,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.62,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.8,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.05,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.94,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.17,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,86.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.05,
Draining or injecting medication into a small joint/bursa without ultrasound,20905600,CDM,510,RC,,,outpatient,,,26.25,13.13,,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,24.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.75,102.86,
SG HBPC I & D PERIAL ABSCESS SUPERFICI,20906050,CDM,510,RC,,,outpatient,,,299,149.5,,290.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,179.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,190.83,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,269.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,269.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,179.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,217.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,204.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,179.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,241.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,241.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,264.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,198.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,242.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,275.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,284.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,290.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,194.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,179.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,179.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,179.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,269.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,179.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,179.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,269.1,
SG HBPC INC THROMBOSED HEMORRHOID EXTERN,20906083,CDM,510,RC,,,outpatient,,,117.25,58.63,,113.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,105.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,80.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,107.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,111.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,105.53,
SG HBPC INCISION DRAIGE VULVA PERINEAL,20906405,CDM,510,RC,,,outpatient,,,37.5,18.75,,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.84,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,24.86,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,34.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,36.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,22.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,102.86,
SG HBPC CATH REMOVAL TUNNELED W/O PUMP,20906589,CDM,510,RC,,,outpatient,,,101.5,50.75,,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,82.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,93.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.46,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,60.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
SG HBPC ANOSCOPY,20906600,CDM,510,RC,,,outpatient,,,76.25,38.13,,73.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.5,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.76,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,73.96,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.75,102.86,
Destruction of 1-14 common or plantar warts,20907110,CDM,510,RC,,,outpatient,,,95.5,47.75,,92.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,85.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,65.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,63.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,77.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,87.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,90.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,92.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.3,102.86,
Chemical destruction of pre-cancerous lesions of the skin,20907250,CDM,510,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
SG HBPC NEG PRESSURE WOUND THERAPY <=50,20907605,CDM,510,RC,,,outpatient,,,17.25,8.63,,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,102.86,
SG HBPC DRAIN EXT EAR ABSCESS HEMATOMA S,20909000,CDM,510,RC,,,outpatient,,,142.25,71.13,,137.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.64,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,128.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,128.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,103.5,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,97.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,114.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,126.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,94.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,115.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,130.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,135.14,95,,,percent of total billed charges,Pays at 95% of total billed charges,137.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,92.46,65,,,percent of total billed charges,Pays at 65% of total billed charges,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.03,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,85.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,128.03,
SG HBPC PARACENTESIS ABDOMIL PARA,20909082,CDM,510,RC,,,outpatient,,,420,210,,407.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,252,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,378,90,,,percent of total billed charges,Pays at 90% of total billed charges,378,90,,,percent of total billed charges,Pays at 90% of total billed charges,252,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,305.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,286.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,252,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,339.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,339.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,372.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,278.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,340.2,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,386.4,92,,,percent of total billed charges,Pays at 92% of total billed charges,399,95,,,percent of total billed charges,Pays at 95% of total billed charges,407.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,273,65,,,percent of total billed charges,Pays at 65% of total billed charges,252,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,378,90,,,percent of total billed charges,Pays at 90% of total billed charges,252,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,252,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,378,
SG HBPC REPLACE GASTROSTOMY/CECOSTOMY,20909450,CDM,510,RC,,,outpatient,,,1715.25,857.63,,1663.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,1029.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,577.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,1543.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1543.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1029.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1248.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,1170.66,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,1029.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1384.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1384.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,1519.88,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,1137.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,1389.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,1578.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,1629.49,95,,,percent of total billed charges,Pays at 95% of total billed charges,1663.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,1114.91,65,,,percent of total billed charges,Pays at 65% of total billed charges,1029.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1029.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1029.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1543.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,1029.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,1029.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,1543.73,
Urine test,20988112,CDM,311,RC,,,outpatient,,,116.75,58.38,,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,107.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,105.08,
SG SURG PATH III,20988304,CDM,310,RC,,,outpatient,,,62,31,,60.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,42.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,54.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,41.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,50.22,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,57.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,58.9,95,,,percent of total billed charges,Pays at 95% of total billed charges,60.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.3,65,,,percent of total billed charges,Pays at 65% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,37.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.2,102.86,
Test of tissues for diagnosis of abnormalities,20988305,CDM,310,RC,,,outpatient,,,196.5,98.25,,190.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,117.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,176.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,176.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.97,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,134.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,117.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,158.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,158.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,130.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,159.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,180.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,186.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,190.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,127.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,117.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,176.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,117.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,176.85,
Blood test to assist with diagnosis,20988312,CDM,310,RC,,,outpatient,,,144,72,,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,116.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,136.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,129.6,
SG IMMUNOCHEM  EA ADDT'L SINGLE,20988341,CDM,310,RC,,,outpatient,,,106.75,53.38,,103.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,72.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Pathology test,20988342,CDM,310,RC,,,outpatient,,,149.5,74.75,,145.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.55,
GYN NEXPLANON,23500001,CDM,250,RC,,,outpatient,,,951,475.5,,922.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,570.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,934.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,855.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,855.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,570.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,691.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,649.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,570.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,767.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,767.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,842.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,630.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,770.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,874.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,903.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,922.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,618.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,570.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,570.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,570.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,855.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,570.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,570.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,855.9,
Fine Needle Aspiration Biopsy without imaging,23500021,CDM,510,RC,,,outpatient,,,166.25,83.13,,161.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.52,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,149.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,113.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,134.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,147.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,110.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,134.66,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,152.95,92,,,percent of total billed charges,Pays at 92% of total billed charges,157.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,161.26,97,,,percent of total billed charges,Pays at 97% of total billed charges,108.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,99.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,149.63,
GY HBPC INC AND DRAIN ABSC COMP MULTIPLE,23500061,CDM,510,RC,,,outpatient,,,73.25,36.63,,71.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,49.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,59.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,64.91,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,48.56,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,59.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,67.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,69.59,95,,,percent of total billed charges,Pays at 95% of total billed charges,71.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.61,65,,,percent of total billed charges,Pays at 65% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,43.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.95,102.86,
"Puncture aspiration of abscess, hematoma, bulla, or cyst",23500160,CDM,510,RC,,,outpatient,,,68.25,34.13,,66.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,46.58,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,55.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,60.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,45.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,55.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,62.79,92,,,percent of total billed charges,Pays at 92% of total billed charges,64.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,66.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,44.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,40.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,102.86,
US HBPC GUID NEEDLE PLAC RT,23500942,CDM,402,RC,,,outpatient,,,869,434.5,,842.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.2,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,782.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,782.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,632.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,593.09,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,701.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,701.46,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,770.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,576.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,703.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,799.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,825.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,842.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,564.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,782.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,521.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,782.1,
GYN HBPC PUNCH BX SKIN SINGLE LESION,23501107,CDM,510,RC,,,outpatient,,,287.5,143.75,,278.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,258.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,258.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,209.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,196.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,232.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,254.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,190.61,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,232.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,264.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,273.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,278.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,186.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,258.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,172.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,258.75,
Under Excision-Benign Lesions Procedures on the Skin 0.6-1 CM,23501401,CDM,510,RC,,,outpatient,,,101.25,50.63,,98.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,139.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,91.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,91.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,69.1,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,67.13,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,82.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,93.15,92,,,percent of total billed charges,Pays at 92% of total billed charges,96.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,98.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,91.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,60.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
GYN HBPC EXCISION BEN LES 1.1-2.0 CM TRU,23501402,CDM,510,RC,,,outpatient,,,112.5,56.25,,109.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.57,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,101.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.81,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.59,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,91.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,103.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,109.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,73.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
GYN HBPC EXCISION BEN <0.5 CM SKIN SCALP,23501420,CDM,510,RC,,,outpatient,,,85.75,42.88,,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.75,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.39,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,69.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,81.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,83.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,51.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.45,102.86,
GYN HBPC EXCISION BEN 3.1-4.0 CM,23501424,CDM,510,RC,,,outpatient,,,216,108,,209.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,129.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.37,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,194.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,194.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,129.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.16,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,147.42,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,129.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,174.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,174.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,191.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,143.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,174.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,198.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,205.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,209.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,140.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,129.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,194.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,129.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,129.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,194.4,
GY HBPC EXC LESION >4.0 CM SCALP NECK HA,23501426,CDM,510,RC,,,outpatient,,,189,94.5,,183.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,322.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,170.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,170.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,128.99,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,167.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,125.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,153.09,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,173.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,179.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,183.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,122.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,113.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,170.1,
GYN HBPC EXCISION MAL 3.1-4.0 CM,23501624,CDM,510,RC,,,outpatient,,,377.75,188.88,,366.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,226.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,320.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,339.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,339.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,226.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,274.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,257.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,226.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,304.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,304.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,334.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,250.45,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,305.98,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,347.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,358.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,366.42,97,,,percent of total billed charges,Pays at 97% of total billed charges,245.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,226.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,339.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,226.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,226.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,339.98,
GYN HBPC INSERT NONDWELL BLAD CATHETER,23501701,CDM,510,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,102.86,
GYN HBPC CYSTOMETROGRAM SIMPLE,23501725,CDM,510,RC,,,outpatient,,,457.25,228.63,,443.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,274.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.02,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,411.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,411.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,274.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,332.7,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,312.07,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,274.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,369.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,369.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,405.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,303.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,370.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,420.67,92,,,percent of total billed charges,Pays at 92% of total billed charges,434.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,443.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,297.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,274.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,274.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,274.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,411.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,274.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,274.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,411.53,
GYN HBPC CYSTOMETROGRAM COMPLEX,23501726,CDM,510,RC,,,outpatient,,,664.25,332.13,,644.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,398.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,597.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,597.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,398.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,483.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,453.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,398.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,536.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,536.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,588.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,440.4,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,538.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,611.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,631.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,644.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,431.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,398.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,398.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,398.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,597.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,398.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,398.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,597.83,
GYN HBPC INJECTION INTRALESIOL UP-7 LE,23501900,CDM,510,RC,,,outpatient,,,90,45,,87.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.15,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,81,90,,,percent of total billed charges,Pays at 90% of total billed charges,81,90,,,percent of total billed charges,Pays at 90% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,61.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,59.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,72.9,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,82.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,85.5,95,,,percent of total billed charges,Pays at 95% of total billed charges,87.3,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.5,65,,,percent of total billed charges,Pays at 65% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81,90,,,percent of total billed charges,Pays at 90% of total billed charges,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,54,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54,102.86,
GYN HBPC INSERTION NONBIODEGRA DRUG IMPL,23501981,CDM,510,RC,,,outpatient,,,133.75,66.88,,129.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.15,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,88.68,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,108.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,123.05,92,,,percent of total billed charges,Pays at 92% of total billed charges,127.06,95,,,percent of total billed charges,Pays at 95% of total billed charges,129.74,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.94,65,,,percent of total billed charges,Pays at 65% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,80.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,120.38,
GYN HBPC REMOVAL NONBIODEGRAD DRUG DELIV,23501982,CDM,510,RC,,,outpatient,,,120.75,60.38,,117.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,108.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,108.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.41,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.06,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,111.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,114.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,117.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,72.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,108.68,
GYN HBPC REMOVE/INSER NONBIODEG DRUG IMP,23501983,CDM,510,RC,,,outpatient,,,116.75,58.38,,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,107.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,105.08,
Procedure on the bladder,23502000,CDM,510,RC,,,outpatient,,,561.5,280.75,,544.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,505.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,505.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,408.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,383.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,453.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,453.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,497.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,372.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,454.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,516.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,533.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,544.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,364.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,505.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,505.35,
GYN HBPC LAYERED CLOSURE WOUND <2.5 CM,23502031,CDM,510,RC,,,outpatient,,,187.5,93.75,,181.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.18,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,168.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.43,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,127.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,151.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,151.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,166.14,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,124.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,151.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,172.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,178.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,181.88,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,112.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,168.75,
GY HBPC RPR LAYER 2.6-7.5 CM NECK HAND F,23502042,CDM,510,RC,,,outpatient,,,230.5,115.25,,223.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,138.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,275,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,207.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,207.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,138.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.71,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,157.32,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,138.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,186.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,204.25,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,152.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,186.71,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,212.06,92,,,percent of total billed charges,Pays at 92% of total billed charges,218.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,223.59,97,,,percent of total billed charges,Pays at 97% of total billed charges,149.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,138.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,207.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,138.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,138.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,207.45,
GYN HBPC SECONDARY CLOSURE SURGICAL WOUN,23503160,CDM,510,RC,,,outpatient,,,637,318.5,,617.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,382.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,788.47,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,573.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,573.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,382.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,463.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,434.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,382.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,514.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,514.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,564.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,422.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,515.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,586.04,92,,,percent of total billed charges,Pays at 92% of total billed charges,605.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,617.89,97,,,percent of total billed charges,Pays at 97% of total billed charges,414.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,382.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,382.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,382.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,573.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,382.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,382.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,573.3,
GYN HBPC DILATION FEMALE URETHRA INITIAL,23503660,CDM,510,RC,,,outpatient,,,96.5,48.25,,93.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,86.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,65.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.89,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,63.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,78.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,88.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,91.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,93.61,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,57.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.9,102.86,
GYN HBPC DILATION FEMALE URETHRA SUBSEQU,23503661,CDM,510,RC,,,outpatient,,,93,46.5,,90.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,83.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,82.41,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,75.33,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.56,92,,,percent of total billed charges,Pays at 92% of total billed charges,88.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,90.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,55.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.8,102.86,
GYN HBPC INJECT ANES PUDENDAL NERVE,23504430,CDM,510,RC,,,outpatient,,,221.75,110.88,,215.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,133.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.85,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,199.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,199.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,161.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,151.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,133.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,179,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,179,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,196.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,147.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,179.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,204.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,210.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,215.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,144.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,133.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,133.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,133.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,133.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,199.58,
GYN HBPC DRESS DEBRIDE PART THIK BURN SM,23506020,CDM,510,RC,,,outpatient,,,39.25,19.63,,38.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,35.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,35.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,26.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.02,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,31.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,36.11,92,,,percent of total billed charges,Pays at 92% of total billed charges,37.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,38.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,25.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,23.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.55,102.86,
GY HBPC DESTRUCTION LESION VULVA SIMPLE,23506501,CDM,510,RC,,,outpatient,,,64.5,32.25,,62.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.18,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.06,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.76,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,52.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,59.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.28,95,,,percent of total billed charges,Pays at 95% of total billed charges,62.57,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.93,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,38.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.7,102.86,
Transvagil ultrasound of uterus,23506817,CDM,402,RC,,,outpatient,,,496.25,248.13,,481.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,446.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,446.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,361.07,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,338.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,400.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,400.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,439.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,329.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,401.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,456.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,471.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,481.36,97,,,percent of total billed charges,Pays at 97% of total billed charges,322.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,446.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,297.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,446.63,
GYN HBPC BIOPSY VAGI SIMPLE,23507100,CDM,510,RC,,,outpatient,,,56.25,28.13,,54.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,50.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,45.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,51.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,53.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,102.86,
Destruction of 1-14 common or plantar warts,23507110,CDM,510,RC,,,outpatient,,,95.5,47.75,,92.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,85.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,65.18,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,77.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,84.62,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,63.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,77.36,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,87.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,90.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,92.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,62.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,57.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.3,102.86,
GYN HBPC EXCISION VAGIL CYST/TUMOR,23507135,CDM,510,RC,,,outpatient,,,76.75,38.38,,74.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,172.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,69.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,46.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.89,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,62.17,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,46.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,46.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.05,102.86,
GYN HBPC FITTING INSERT PESSARY OR SUPPO,23507160,CDM,510,RC,,,outpatient,,,77.25,38.63,,74.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,46.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.22,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,69.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,46.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,51.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,62.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,71.07,92,,,percent of total billed charges,Pays at 92% of total billed charges,73.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,46.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,46.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,46.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.35,102.86,
GYN HBPC COLPOSCOPY,23507452,CDM,510,RC,,,outpatient,,,46.25,23.13,,44.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.13,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,41.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.65,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.33,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,37.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,42.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,30.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,27.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.75,102.86,
Biopsy of cervix or uterus,23507454,CDM,510,RC,,,outpatient,,,49.5,24.75,,48.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,150.65,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,44.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,44.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.02,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,33.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,29.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,32.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,40.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,45.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,47.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,48.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,32.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,29.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,29.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.7,102.86,
GYN HBPC COLPOSCOPY W BIOPSY,23507455,CDM,510,RC,,,outpatient,,,91.5,45.75,,88.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,82.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,66.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,62.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,60.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,74.12,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,84.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,86.93,95,,,percent of total billed charges,Pays at 95% of total billed charges,88.76,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.48,65,,,percent of total billed charges,Pays at 65% of total billed charges,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,54.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.9,102.86,
GYN HBPC CONIZATION CERVIX FULG D&C LEEP,23507522,CDM,510,RC,,,outpatient,,,60.25,30.13,,58.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,261.45,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.84,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,41.12,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,53.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,39.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,48.8,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,55.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,57.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,58.44,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,36.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.15,102.86,
GYN HBPC NEG PRESSURE WOUND THERAP <= 50,23507605,CDM,510,RC,,,outpatient,,,17.25,8.63,,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,102.86,
Biopsy of the lining of the uterus,23508100,CDM,510,RC,,,outpatient,,,60.75,30.38,,58.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.28,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,54.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,54.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,41.46,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,36.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,53.83,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,40.28,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,49.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,55.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,57.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,58.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,36.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,36.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.45,102.86,
GYN HBPC INSERTION INTRAUTERINE DEVICE,23508300,CDM,510,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.28,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,102.86,
GYN HBPC REMOVAL OF IUD,23508301,CDM,510,RC,,,outpatient,,,70.75,35.38,,68.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.46,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,63.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,63.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.48,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,48.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,42.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.11,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,62.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,46.91,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,57.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,65.09,92,,,percent of total billed charges,Pays at 92% of total billed charges,67.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,68.63,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,42.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,42.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.45,102.86,
GYN HBPC PUNCTURE ASPIR CYST BREAST RT,23509000,CDM,510,RC,,,outpatient,,,247.5,123.75,,240.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,148.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.38,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,222.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,222.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,148.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,180.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,168.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,148.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,199.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,219.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,164.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,200.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,227.7,92,,,percent of total billed charges,Pays at 92% of total billed charges,235.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,240.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,160.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,148.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,148.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,222.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,148.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,148.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,222.75,
GYN HBPC CATH FOR SPECIMEN COLLECTION,23509612,CDM,300,RC,,,outpatient,,,6.75,3.38,,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,6.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,,,,,Other,Not Separately reimbursable,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.08,100,
3-dose HPV vaccition,23590649,CDM,250,RC,,,outpatient,,,340.75,170.38,,330.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,204.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,306.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,306.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,204.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,232.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,204.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,275.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,275.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,301.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,225.92,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,276.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,313.49,92,,,percent of total billed charges,Pays at 92% of total billed charges,323.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,330.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,221.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,204.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,204.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,204.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,306.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,204.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,204.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,306.68,
GY THER INJ SQ OR IM,23596372,CDM,510,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
FK NEXPLANON,25000003,CDM,250,RC,,,outpatient,,,951,475.5,,922.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,570.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,934.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,855.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,855.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,570.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,691.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,649.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,570.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,767.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,767.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,842.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,630.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,770.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,874.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,903.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,922.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,618.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,570.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,570.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,570.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,855.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,570.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,570.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,855.9,
Immunization administration by a medical assistant or nurse,25000005,CDM,771,RC,,,outpatient,,,23.75,11.88,,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,102.86,
FK VFC VACCINE ADMINISTRATION EA ADDL,25000006,CDM,771,RC,,,outpatient,,,23.75,11.88,,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,102.86,
Outpatient visit of established patient not requiring a physician,25000011,CDM,510,RC,,,outpatient,,,26.75,13.38,,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,102.86,
Outpatient visit of established patient requiring a physician,25000012,CDM,510,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,102.86,
"Established patient office or other outpatient visit, typically 15 minutes",25000013,CDM,510,RC,,,outpatient,,,40.25,20.13,,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,102.86,
"Established patient office or other outpatient visit, typically 25 minutes",25000014,CDM,510,RC,,,outpatient,,,65.5,32.75,,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,53.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,60.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,62.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,102.86,
"Established patient office or other outpatient, visit typically 40 minutes",25000015,CDM,510,RC,,,outpatient,,,99,49.5,,96.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,80.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,91.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,94.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,96.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,102.86,
FK PFIZER COVID 19 VAC ADMIN 1ST DOSE,25000019,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
Immunization administration by a medical assistant or nurse,25000020,CDM,771,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,102.86,
Immunization administration by a medical assistant or nurse,25000021,CDM,771,RC,,,outpatient,,,28.25,14.13,,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,102.86,
Immunization administration by a medical assistant or nurse,25000022,CDM,771,RC,,,outpatient,,,45.5,22.75,,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,41.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,102.86,
FK PFIZER COVID 19 VAC ADMIN 3RD DOSE,25000025,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
FK PFIZER COVID 19 VAC ADMIN 2ND DOSE,25000029,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
FK PFIZER COVID 19 VAC ADMIN BOOSTER,25000049,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
FK DIABETES SELF MGMT TRAINING 30 MIN,25000112,CDM,942,RC,,,outpatient,,,44.25,22.13,,42.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.38,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,42.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.55,90,
FK MODER COVID 19 VAC ADMIN 1ST DOSE,25000119,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
FK MODER COVID 19 VAC ADMIN 2ND DOSE,25000129,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
FK MODER COVID 19 VAC ADMIN 3RD DOSE,25000139,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
FK JANSSEN COVID 19 VAC ADMIN,25000319,CDM,771,RC,,,outpatient,,,88.25,44.13,,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,81.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,90,
FK JANSSEN COVID 19 VAC ADMIN BOOSTER,25000349,CDM,771,RC,,,outpatient,,,88.25,44.13,,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,81.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,90,
Hepatitis A vaccition for adults,25000632,CDM,250,RC,,,outpatient,,,144.75,72.38,,140.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,133.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.28,
Hepatitis A vaccition for adolescents and children,25000633,CDM,636,RC,,,outpatient,,,116.5,58.25,,113.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,104.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,104.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.23,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.37,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,107.18,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,69.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,104.85,
FK HIB PRPT(ACTHIB):0.5 ML,25000648,CDM,636,RC,,,outpatient,,,114,57,,110.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,102.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,102.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,75.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,92.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,104.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,108.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,110.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
3-dose HPV vaccition,25000649,CDM,636,RC,,,outpatient,,,343.5,171.75,,333.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,206.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,309.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,309.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,206.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,249.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,234.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,206.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,277.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,277.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,304.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,227.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,278.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,316.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,326.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,333.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,223.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,206.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,309.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,206.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,206.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,309.15,
FK HPV-9 (GARDASIL 9),25000651,CDM,636,RC,,,outpatient,,,680.75,340.38,,660.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,408.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,612.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,612.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,408.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,495.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,464.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,408.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,549.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,549.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,603.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,451.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,551.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,626.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,646.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,660.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,442.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,408.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,408.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,408.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,612.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,408.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,408.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,612.68,
FK PCV 13 PNEUMOCOCCAL (PREVR),25000670,CDM,636,RC,,,outpatient,,,365,182.5,,354.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,219,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,328.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,328.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,219,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,265.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,249.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,219,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,294.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,294.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,323.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,242,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,295.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,335.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,346.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,354.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,237.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,219,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,219,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,219,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,219,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,219,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,328.5,
FK ROTAVIRUS (ROTATEQ),25000680,CDM,636,RC,,,outpatient,,,175.5,87.75,,170.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.1,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,157.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,119.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,116.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,142.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,161.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,166.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,170.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,157.95,
FK DTaP/IPV (QUADRACEL) (KINRIX),25000696,CDM,636,RC,,,outpatient,,,169,84.5,,163.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,152.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,115.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,149.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,112.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,136.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,155.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,160.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,163.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,152.1,
FK DTAP/IPV/HIB (PENTACEL),25000698,CDM,636,RC,,,outpatient,,,189.5,94.75,,183.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,170.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,170.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,129.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,113.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,167.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,125.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,153.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,174.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,180.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,183.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,123.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,113.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,113.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,170.55,
FK DTaP (DAPTACEL) (INFANRIX),25000700,CDM,636,RC,,,outpatient,,,76,38,,73.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.2,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,69.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,73.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.6,102.86,
"Measles, mumps and rubella vaccine",25000707,CDM,636,RC,,,outpatient,,,140,70,,135.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,126,90,,,percent of total billed charges,Pays at 90% of total billed charges,126,90,,,percent of total billed charges,Pays at 90% of total billed charges,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,124.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,113.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,128.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,133,95,,,percent of total billed charges,Pays at 95% of total billed charges,135.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,91,65,,,percent of total billed charges,Pays at 65% of total billed charges,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126,90,,,percent of total billed charges,Pays at 90% of total billed charges,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,126,
"measlesMeasles, mumps, rubella and varicella vaccine",25000710,CDM,636,RC,,,outpatient,,,417,208.5,,404.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,250.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,375.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,375.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,303.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,284.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,250.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,336.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,336.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,369.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,276.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,337.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,383.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,396.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,404.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,271.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,250.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,375.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,250.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,375.3,
FK POLIOVIRUS VACCINE (IPV),25000713,CDM,636,RC,,,outpatient,,,134.75,67.38,,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,123.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.28,
FK TETANUS/DIPHTHERIA(TENIVAC)INJ: 0.5ML,25000714,CDM,636,RC,,,outpatient,,,94.75,47.38,,91.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,56.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,85.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,85.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.94,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,64.67,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,56.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,76.48,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,83.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,62.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,76.75,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,87.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,90.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,91.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,61.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,56.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,56.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,56.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,56.85,102.86,
"Diphtheria, tetanus acellular, and pertussis vaccine for adults",25000715,CDM,636,RC,,,outpatient,,,380.25,190.13,,368.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,228.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,342.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,342.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,228.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,276.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,259.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,228.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,306.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,306.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,336.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,252.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,308,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,349.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,361.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,368.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,247.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,228.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,228.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,228.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,342.23,
Varicella vaccine,25000716,CDM,636,RC,,,outpatient,,,249.25,124.63,,241.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,224.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,170.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,201.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,220.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,165.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,201.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,229.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,236.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,241.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,162.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,224.33,
FK DTAP/HEPB/IPV (PEDIARIX),25000723,CDM,636,RC,,,outpatient,,,134.75,67.38,,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.1,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,123.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.28,
FK PEDS PFIZER COVID19 VAC ADMIN 2ND DOS,25000729,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
pneumococcal Pneumococcal vaccine,25000732,CDM,636,RC,,,outpatient,,,159.25,79.63,,154.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,143.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,143.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,108.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,105.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,128.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,146.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,151.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,154.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,143.33,
meningococcal Meningococcal conjugate vaccine,25000734,CDM,636,RC,,,outpatient,,,244.75,122.38,,237.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.5,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,220.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,220.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,167.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,146.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,197.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,216.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,162.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,198.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,225.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,232.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,237.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,159.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,146.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,220.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,146.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,220.28,
FK ENERGIX B,25000744,CDM,636,RC,,,outpatient,,,48.75,24.38,,47.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.9,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,43.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,33.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,32.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,39.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,44.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,46.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,47.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,102.86,
"Removal of skin tags, multiple fibrocutaneous tags, any area",25001200,CDM,510,RC,,,outpatient,,,32,16,,31.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.66,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,28.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.83,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.36,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.22,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.92,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,29.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,30.4,95,,,percent of total billed charges,Pays at 95% of total billed charges,31.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.8,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.8,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,19.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.2,102.86,
FK IV INF/HYD INT UP-1HR MOD 59,25006360,CDM,510,RC,,,outpatient,,,274.75,137.38,,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.28,
FK IV HYD EA ADD HR MOD 59,25006361,CDM,510,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",25006365,CDM,510,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",25006366,CDM,510,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
FK INFUSION SQ MED IN UP TO 1 HR MOD 59,25006369,CDM,510,RC,,,outpatient,,,307.5,153.75,,298.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,276.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,276.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,209.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,248.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,272.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,203.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,249.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,282.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,292.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,298.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,199.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,276.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,276.75,
FK THER INJ SQ OR IM MOD 59,25006372,CDM,510,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",25006374,CDM,510,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",25006375,CDM,510,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
FK PORT FLUSH ONLY MOD 59,25006523,CDM,510,RC,,,outpatient,,,92.5,46.25,,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,74.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,102.86,
FK PEDS PFIZER COVID19 VAC ADMIN 1ST DOS,25007019,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
Flu test,25007804,CDM,300,RC,,,outpatient,,,110.25,55.13,,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,80.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,75.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,73.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.34,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,101.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,104.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,102.86,
FK HBPC REMOVAL IMPACTED CERUM IRRG/LAVA,25009209,CDM,510,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,102.86,
FK CATH FOR SPECIMEN COLLECTION,25009612,CDM,300,RC,,,outpatient,,,34.5,17.25,,33.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.57,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,31.74,92,,,percent of total billed charges,Pays at 92% of total billed charges,32.78,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.43,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.05,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,,,,,Other,Not Separately reimbursable,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.57,100,
FK ZOSTER VACCINE (SHINGRIX)50MCG/0.5ML,25012940,CDM,636,RC,,,outpatient,,,311.25,155.63,,301.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.08,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,280.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,280.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,212.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,251.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,275.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,206.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,252.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,286.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,295.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,301.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,202.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,280.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,280.13,
Manual urilysis test with examition without using microscope,25081002,CDM,300,RC,,,outpatient,,,20.25,10.13,,19.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.71,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.7,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,18.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.48,102.86,
Urine pregncy test,25081025,CDM,300,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.62,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.61,102.86,
FK OCCULT BLOOD 1-3 TESTS SCREENING,25082270,CDM,300,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.91,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.38,102.86,
FK GLUCOSE WHOLE BLOOD LAB FINGE,25082948,CDM,300,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.8,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.04,102.86,
Blood test to measure levels of hemoglobin,25085018,CDM,300,RC,,,outpatient,,,18.5,9.25,,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.2,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,17.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.37,102.86,
FK TUBERCULIN SKIN TEST (PPD),25086580,CDM,300,RC,,,outpatient,,,12.5,6.25,,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,102.86,
A lab test to screen for evidence of vagil infection,25087210,CDM,300,RC,,,outpatient,,,34.75,17.38,,33.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.86,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,31.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.82,102.86,
FK KOH PREP SKIN HAIR ILS,25087220,CDM,300,RC,,,outpatient,,,42.5,21.25,,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.71,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.76,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,39.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,102.86,
Flu test,25087804,CDM,300,RC,,,outpatient,,,110.25,55.13,,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,80.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,75.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,73.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.34,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,101.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,104.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,102.86,
Test for strep A,25087880,CDM,300,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.32,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.53,102.86,
Immunization administration in children <18,25090460,CDM,771,RC,,,outpatient,,,56.25,28.13,,54.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,50.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,45.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,51.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,53.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,102.86,
FK VACCINE COUNSELING < 18 YR ADD'TL,25090461,CDM,771,RC,,,outpatient,,,29.25,14.63,,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,102.86,
Immunization administration by a medical assistant or nurse,25090471,CDM,771,RC,,,outpatient,,,45.5,22.75,,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,41.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,102.86,
FK VACCINE ADMINISTRATION EA ADDL,25090472,CDM,771,RC,,,outpatient,,,23.75,11.88,,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,102.86,
FK FLU MIST ADMINISTRATION/ORAL VACCINE,25090473,CDM,771,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,102.86,
Immunization administered orally or sally,25090474,CDM,771,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,102.86,
FK VFC ACTHIB,25090697,CDM,250,RC,,,outpatient,,,0.01,0.01,,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,0.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,0.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,0.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,0.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,0.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,102.86,
Hepatitis B vaccine,25090746,CDM,250,RC,,,outpatient,,,121.5,60.75,,117.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,109.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,109.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,88.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,82.92,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,98.07,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,107.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,80.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,98.42,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,111.78,92,,,percent of total billed charges,Pays at 92% of total billed charges,115.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,117.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,109.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,72.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,109.35,
FK HBPC CHRONIC CARE EACH ADDTL 20 MIN,25092058,CDM,510,RC,,,outpatient,,,27.5,13.75,,26.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,24.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.23,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,26.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,16.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.5,90,
FK AUDIOMETRY SCREEN TEST PURE TONE AIR,25092551,CDM,471,RC,,,outpatient,,,21.75,10.88,,21.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.14,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,21.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,102.86,
Type of hearing test,25092552,CDM,471,RC,,,outpatient,,,44.75,22.38,,43.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.09,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,40.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,41.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,42.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,43.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.85,102.86,
FK EKG TRACING ONLY,25093005,CDM,730,RC,,,outpatient,,,130.75,65.38,,126.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,105.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,120.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,124.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117.68,
FK ECG 1-3 LEADS TECH,25093041,CDM,730,RC,,,outpatient,,,52.5,26.25,,50.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,35.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,49.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,50.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.5,102.86,
Test to determine how well oxygen moves from the lungs to the blood stream,25094010,CDM,460,RC,,,outpatient,,,46,23,,44.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,37.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,42.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,102.86,
"FK RESPIR NEBULIZER TREATMENT, INITIAL",25094640,CDM,410,RC,,,outpatient,,,81.25,40.63,,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,55.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,65.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,74.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,77.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,102.86,
Allergy shot-1 shot,25095115,CDM,510,RC,,,outpatient,,,35.75,17.88,,34.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.02,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,102.86,
Multiple allergy shots,25095117,CDM,510,RC,,,outpatient,,,46,23,,44.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,37.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,42.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,102.86,
FK IV INF/HYD INT UP-1HR,25096360,CDM,510,RC,,,outpatient,,,274.75,137.38,,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.28,
FK IV HYD EA ADD HR,25096361,CDM,510,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",25096365,CDM,510,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",25096366,CDM,510,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
FK INFUSION SQ MED INITIAL UP TO 1 HR,25096369,CDM,510,RC,,,outpatient,,,307.5,153.75,,298.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,276.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,276.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,209.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,248.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,272.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,203.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,249.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,282.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,292.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,298.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,199.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,276.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,276.75,
FK THER INJ SQ OR IM,25096372,CDM,510,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",25096374,CDM,510,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",25096375,CDM,510,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-same drug add on",25096376,CDM,510,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,102.86,
FK PORT FLUSH ONLY,25096523,CDM,510,RC,,,outpatient,,,92.5,46.25,,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,74.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,102.86,
Eye test,25099173,CDM,510,RC,,,outpatient,,,11,5.5,,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.58,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,102.86,
FK HBPC CHRONIC CARE MGMT EA ADDTL 20 M,25099439,CDM,510,RC,,,outpatient,,,25.25,12.63,,24.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.58,30,,,percent of total billed charges,Pays at 30% of total billed charges,22.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23.23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.99,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.41,65,,,percent of total billed charges,Pays at 65% of total billed charges,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.73,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.15,102.86,
FK CHRONIC CARE MGMT CMP 60 MIN N F TO F,25099487,CDM,510,RC,,,outpatient,,,97,48.5,,94.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.5,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.58,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,66.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.3,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,85.95,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,64.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,78.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,89.24,92,,,percent of total billed charges,Pays at 92% of total billed charges,92.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,94.09,97,,,percent of total billed charges,Pays at 97% of total billed charges,63.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,58.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.2,102.86,
FK CHRONIC CARE MGMT CMP EA Add 30 NFF,25099489,CDM,510,RC,,,outpatient,,,48.25,24.13,,46.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.75,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,43.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.93,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.95,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.99,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,39.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,44.39,92,,,percent of total billed charges,Pays at 92% of total billed charges,45.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,46.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,28.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.95,102.86,
FK CHRONIC CARE MGMT 20 MIN NON F TO F,25099490,CDM,510,RC,,,outpatient,,,31,15.5,,30.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,21.16,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,20.55,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,25.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,28.52,92,,,percent of total billed charges,Pays at 92% of total billed charges,29.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,30.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,18.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.6,102.86,
FK HBPC CHRONIC CARE MGMT 30 MIN OR >/MT,25099491,CDM,510,RC,,,outpatient,,,85,42.5,,82.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,51,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,76.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,76.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,51,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,58.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,51,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,68.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,75.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,56.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,68.85,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,78.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,80.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,82.45,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,51,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,76.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,51,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,51,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51,102.86,
FK ADVANCE CARE PLAN DURNG AWV 1ST 30 MN,25099497,CDM,510,RC,,,outpatient,,,146.25,73.13,,141.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,99.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,129.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,96.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,118.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,134.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,138.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,141.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,131.63,
FK ADVANCE CARE PLANNING EA ADDL 30 MIN,25099498,CDM,510,RC,,,outpatient,,,146.25,73.13,,141.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,99.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,129.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,96.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,118.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,134.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,138.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,141.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,131.63,
FK PAP EXAM (MEDICARE INCLUDING BREAST),25099998,CDM,770,RC,,,outpatient,,,84,42,,81.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,75.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,57.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,55.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,68.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,77.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,79.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,81.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.4,90,
Immunization administration by a medical assistant or nurse,25500005,CDM,771,RC,,,outpatient,,,23.75,11.88,,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,102.86,
FF VFC VACCINE ADMINISTRATION EA ADDL,25500006,CDM,771,RC,,,outpatient,,,23.75,11.88,,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,102.86,
FF PFIZER COVID 19 VAC ADMIN 1ST DOSE,25500019,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
Immunization administration by a medical assistant or nurse,25500020,CDM,771,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,102.86,
Immunization administration by a medical assistant or nurse,25500021,CDM,771,RC,,,outpatient,,,28.25,14.13,,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,102.86,
Immunization administration by a medical assistant or nurse,25500022,CDM,771,RC,,,outpatient,,,45.5,22.75,,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,41.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,102.86,
FF PFIZER COVID 19 VAC ADMIN 3RD DOSE,25500025,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
FF PFIZER COVID 19 VAC ADMIN 2ND DOSE,25500029,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
FF HIB PRPT(HIBERIX):0.5 ML,25500048,CDM,636,RC,,,outpatient,,,226,113,,219.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,203.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,203.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.44,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,154.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,182.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,200.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,149.84,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,183.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,207.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,214.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,219.22,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,135.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,203.4,
FF PFIZER COVID 19 VAC ADMIN BOOSTER,25500049,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
Hepatitis A vaccition for adults,25500063,CDM,636,RC,,,outpatient,,,141,70.5,,136.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,126.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,126.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.59,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,96.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.82,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,124.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,93.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,114.21,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,129.72,92,,,percent of total billed charges,Pays at 92% of total billed charges,133.95,95,,,percent of total billed charges,Pays at 95% of total billed charges,136.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,91.65,65,,,percent of total billed charges,Pays at 65% of total billed charges,84.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,84.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,84.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,126.9,
FF DIABETES SELF MGMT TRAINING 30 MIN,25500112,CDM,942,RC,,,outpatient,,,44.25,22.13,,42.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.38,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,42.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.55,90,
FF MODER COVID 19 VAC ADMIN 1ST DOSE,25500119,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
FF MODER COVID 19 VAC ADMIN 2ND DOSE,25500129,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
FF MODER COVID 19 VAC ADMIN 3RD DOSE,25500139,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
Hepatitis A vaccition for adolescents and children,25500633,CDM,636,RC,,,outpatient,,,117.5,58.75,,113.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,105.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.49,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,80.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,70.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.85,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,104.12,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,95.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,108.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,111.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,70.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,70.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,105.75,
FF HIB PRPT(ACTHIB):0.5 ML,25500648,CDM,636,RC,,,outpatient,,,114,57,,110.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,102.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,102.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,77.81,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,92.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,92.02,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,101.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,75.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,92.34,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,104.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,108.3,95,,,percent of total billed charges,Pays at 95% of total billed charges,110.58,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.1,65,,,percent of total billed charges,Pays at 65% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,68.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
3-dose HPV vaccition,25500649,CDM,636,RC,,,outpatient,,,343.5,171.75,,333.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,206.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.4,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,309.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,309.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,206.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,249.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,234.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,206.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,277.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,277.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,304.38,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,227.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,278.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,316.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,326.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,333.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,223.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,206.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,206.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,309.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,206.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,206.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,309.15,
FF HPV-9 (GARDASIL 9),25500651,CDM,636,RC,,,outpatient,,,680.75,340.38,,660.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,408.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,612.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,612.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,408.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,495.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,464.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,408.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,549.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,549.5,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,603.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,451.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,551.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,626.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,646.71,95,,,percent of total billed charges,Pays at 95% of total billed charges,660.33,97,,,percent of total billed charges,Pays at 97% of total billed charges,442.49,65,,,percent of total billed charges,Pays at 65% of total billed charges,408.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,408.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,408.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,612.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,408.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,408.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,612.68,
FF PCV 13 PNEUMOCOCCAL (PREVR),25500670,CDM,636,RC,,,outpatient,,,365,182.5,,354.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,219,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,328.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,328.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,219,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,265.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,249.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,219,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,294.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,294.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,323.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,242,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,295.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,335.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,346.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,354.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,237.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,219,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,219,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,219,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,219,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,219,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,328.5,
FF ROTAVIRUS (ROTATEQ),25500680,CDM,636,RC,,,outpatient,,,175.5,87.75,,170.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.1,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,157.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,157.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,127.69,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,119.78,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,141.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,155.51,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,116.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,142.16,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,161.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,166.73,95,,,percent of total billed charges,Pays at 95% of total billed charges,170.24,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.08,65,,,percent of total billed charges,Pays at 65% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,157.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,105.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,157.95,
FF DTaP/IPV (QUADRACEL) (KINRIX),25500696,CDM,636,RC,,,outpatient,,,169,84.5,,163.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,53.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,152.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,122.96,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,115.34,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,136.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,136.42,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,149.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,112.05,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,136.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,155.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,160.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,163.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,109.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,101.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,152.1,
FF DTAP/HIB/IPV (PENTACEL),25500698,CDM,636,RC,,,outpatient,,,189.5,94.75,,183.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,113.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,97.43,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,170.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,170.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,137.88,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,129.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,113.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.96,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,167.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,125.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,153.5,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,174.34,92,,,percent of total billed charges,Pays at 92% of total billed charges,180.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,183.82,97,,,percent of total billed charges,Pays at 97% of total billed charges,123.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,113.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,170.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,113.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,113.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,170.55,
FF DTaP (DAPTACEL)(INFANRIX),25500700,CDM,636,RC,,,outpatient,,,76,38,,73.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.2,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,51.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.34,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,69.92,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.2,95,,,percent of total billed charges,Pays at 95% of total billed charges,73.72,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.4,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.6,102.86,
"Measles, mumps and rubella vaccine",25500707,CDM,636,RC,,,outpatient,,,140,70,,135.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.87,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,126,90,,,percent of total billed charges,Pays at 90% of total billed charges,126,90,,,percent of total billed charges,Pays at 90% of total billed charges,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,101.86,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,95.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,113.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,113.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,124.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,92.82,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,113.4,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,128.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,133,95,,,percent of total billed charges,Pays at 95% of total billed charges,135.8,97,,,percent of total billed charges,Pays at 97% of total billed charges,91,65,,,percent of total billed charges,Pays at 65% of total billed charges,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,126,90,,,percent of total billed charges,Pays at 90% of total billed charges,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,84,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,126,
"measlesMeasles, mumps, rubella and varicella vaccine",25500710,CDM,636,RC,,,outpatient,,,417,208.5,,404.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,250.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.92,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,375.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,375.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,303.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,284.6,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,250.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,336.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,336.6,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,369.5,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,276.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,337.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,383.64,92,,,percent of total billed charges,Pays at 92% of total billed charges,396.15,95,,,percent of total billed charges,Pays at 95% of total billed charges,404.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,271.05,65,,,percent of total billed charges,Pays at 65% of total billed charges,250.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,250.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,375.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,250.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,250.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,375.3,
FF POLIOVIRUS VACCINE (IPV),25500713,CDM,636,RC,,,outpatient,,,60,30,,58.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,36,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.07,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,54,90,,,percent of total billed charges,Pays at 90% of total billed charges,54,90,,,percent of total billed charges,Pays at 90% of total billed charges,36,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,40.95,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,36,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,48.43,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,53.17,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,39.78,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,48.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,55.2,92,,,percent of total billed charges,Pays at 92% of total billed charges,57,95,,,percent of total billed charges,Pays at 95% of total billed charges,58.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,39,65,,,percent of total billed charges,Pays at 65% of total billed charges,36,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,54,90,,,percent of total billed charges,Pays at 90% of total billed charges,36,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,36,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36,102.86,
FF Td (TENIVAC)INJ: 0.5ML,25500714,CDM,636,RC,,,outpatient,,,78.75,39.38,,76.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,70.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,53.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,63.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,72.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,74.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,76.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,102.86,
"Diphtheria, tetanus acellular, and pertussis vaccine for adults",25500715,CDM,636,RC,,,outpatient,,,380.25,190.13,,368.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,228.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,342.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,342.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,228.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,276.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,259.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,228.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,306.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,306.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,336.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,252.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,308,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,349.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,361.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,368.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,247.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,228.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,228.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,228.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,342.23,
Varicella vaccine,25500716,CDM,636,RC,,,outpatient,,,249.25,124.63,,241.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,224.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,224.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,181.35,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,170.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,201.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,201.19,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,220.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,165.25,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,201.89,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,229.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,236.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,241.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,162.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,224.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,149.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,224.33,
FF DTAP/HEPB/IPV (PEDIARIX),25500723,CDM,636,RC,,,outpatient,,,134.75,67.38,,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.1,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.04,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,91.97,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,108.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,119.4,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,89.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,109.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,123.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,128.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,130.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,80.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,121.28,
pneumococcal Pneumococcal vaccine,25500732,CDM,636,RC,,,outpatient,,,159.25,79.63,,154.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,143.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,143.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,108.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,105.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,128.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,146.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,151.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,154.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,143.33,
meningococcal Meningococcal conjugate vaccine,25500734,CDM,636,RC,,,outpatient,,,244.75,122.38,,237.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.5,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,220.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,220.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,167.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,146.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,197.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,216.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,162.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,198.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,225.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,232.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,237.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,159.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,146.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,220.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,146.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,220.28,
FF HEP B (ENERGIX B),25500744,CDM,636,RC,,,outpatient,,,48.75,24.38,,47.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.9,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,43.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,43.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,33.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,43.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,32.32,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,39.49,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,44.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,46.31,95,,,percent of total billed charges,Pays at 95% of total billed charges,47.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.69,65,,,percent of total billed charges,Pays at 65% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,43.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,29.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.25,102.86,
Hepatitis B vaccine,25500746,CDM,636,RC,,,outpatient,,,124.25,62.13,,120.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,74.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.06,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,111.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.4,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,84.8,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,74.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,100.29,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.1,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,82.38,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,100.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,114.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,118.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,120.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,80.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,74.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,74.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,111.83,
FF IV INF/HYD INT UP-1HR MOD 59,25506360,CDM,510,RC,,,outpatient,,,274.75,137.38,,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.28,
FF IV HYD EA ADD HR MOD 59,25506361,CDM,510,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",25506365,CDM,510,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",25506366,CDM,510,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
FF INFUSION SQ MED IN UP TO 1 HR MOD 59,25506369,CDM,510,RC,,,outpatient,,,307.5,153.75,,298.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,276.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,276.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,209.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,248.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,272.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,203.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,249.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,282.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,292.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,298.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,199.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,276.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,276.75,
FF THER INJ SQ OR IM MOD 59,25506372,CDM,510,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",25506374,CDM,510,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",25506375,CDM,510,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
FF PORT FLUSH ONLY MOD 59,25506523,CDM,510,RC,,,outpatient,,,92.5,46.25,,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,74.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,102.86,
Flu test,25507804,CDM,300,RC,,,outpatient,,,110.25,55.13,,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,80.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,75.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,73.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.34,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,101.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,104.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,102.86,
FF HBPC REMOVAL IMPACTED CERUM IRRG/LAV,25509209,CDM,510,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,102.86,
FF ZOSTER VACCINE (SHINGRIX)50MCG/0.5ML,25512940,CDM,636,RC,,,outpatient,,,311.25,155.63,,301.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.08,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,280.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,280.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,212.43,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,251.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,251.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,275.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,206.36,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,252.11,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,286.35,92,,,percent of total billed charges,Pays at 92% of total billed charges,295.69,95,,,percent of total billed charges,Pays at 95% of total billed charges,301.91,97,,,percent of total billed charges,Pays at 97% of total billed charges,202.31,65,,,percent of total billed charges,Pays at 65% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,280.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,186.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,280.13,
Collection of venous blood by venipuncture,25536415,CDM,300,RC,,,outpatient,,,18.5,9.25,,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.57,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,17.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.57,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.57,102.86,
FF MONO TEST,25576308,CDM,300,RC,,,outpatient,,,65.5,32.75,,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.99,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,60.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,62.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,102.86,
Manual urilysis test with examition without using microscope,25581002,CDM,300,RC,,,outpatient,,,20.25,10.13,,19.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.71,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.7,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,18.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.48,102.86,
Urine pregncy test,25581025,CDM,300,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.62,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.61,102.86,
FF OCCULT BLOOD 1-3 TESTS SCREENING,25582270,CDM,300,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.91,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.38,102.86,
FF OCCULT DIAG BLD POC 1-3 CARDS,25582272,CDM,300,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.3,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.71,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.23,102.86,
FF GLUCOSE WHOLE BLOOD LAB FINGE,25582948,CDM,300,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.8,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.04,102.86,
Blood test to measure levels of hemoglobin,25585018,CDM,300,RC,,,outpatient,,,18.5,9.25,,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.2,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,17.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.37,102.86,
FF TUBERCULIN SKIN TEST (PPD),25586580,CDM,300,RC,,,outpatient,,,12.5,6.25,,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,102.86,
A lab test to screen for evidence of vagil infection,25587210,CDM,300,RC,,,outpatient,,,34.75,17.38,,33.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.86,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,31.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.82,102.86,
FF KOH PREP SKIN HAIR ILS,25587220,CDM,300,RC,,,outpatient,,,42.5,21.25,,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.71,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.76,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,39.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,102.86,
Flu test,25587804,CDM,300,RC,,,outpatient,,,110.25,55.13,,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,80.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,75.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,73.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.34,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,101.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,104.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,102.86,
Test for strep A,25587880,CDM,300,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.32,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.53,102.86,
Urine test,25588112,CDM,311,RC,,,outpatient,,,117.25,58.63,,113.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,105.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,85.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,80.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.64,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.9,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,107.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,111.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,76.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,70.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,105.53,
Immunization administration in children <18,25590460,CDM,510,RC,,,outpatient,,,56.25,28.13,,54.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,50.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.93,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.39,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.41,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,49.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,45.56,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,51.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,53.44,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.56,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.56,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,33.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.75,102.86,
FF VACCINE COUNSELING < 18 YR ADD'TL,25590461,CDM,510,RC,,,outpatient,,,29.25,14.63,,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,102.86,
Immunization administration by a medical assistant or nurse,25590471,CDM,771,RC,,,outpatient,,,45.5,22.75,,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,41.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,102.86,
FF VACCINE ADMINISTRATION EA ADD,25590472,CDM,771,RC,,,outpatient,,,23.75,11.88,,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,102.86,
FF FLU MIST ADMINISTRATION/ORAL VACCINE,25590473,CDM,771,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,102.86,
Immunization administered orally or sally,25590474,CDM,771,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,102.86,
FF VFC MENINGOCOCCAL GROUP B TRUMENBA,25590621,CDM,250,RC,,,outpatient,,,0.01,0.01,,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,142.31,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,0.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,0.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,0.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,0.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,0.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,102.86,
FF AUDIOMETRY SCREEN TEST PURE TONE AIR,25592551,CDM,471,RC,,,outpatient,,,21.75,10.88,,21.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.14,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,21.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,102.86,
Type of hearing test,25592552,CDM,471,RC,,,outpatient,,,44.75,22.38,,43.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.09,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,40.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,41.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,42.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,43.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.85,102.86,
FF EKG TRACING ONLY,25593005,CDM,730,RC,,,outpatient,,,130.75,65.38,,126.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,105.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,120.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,124.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117.68,
FF ECG 1-3 LEADS TECH,25593041,CDM,730,RC,,,outpatient,,,52.5,26.25,,50.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,35.83,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.38,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.52,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,34.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.3,92,,,percent of total billed charges,Pays at 92% of total billed charges,49.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,50.93,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,31.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.5,102.86,
Test to determine how well oxygen moves from the lungs to the blood stream,25594010,CDM,460,RC,,,outpatient,,,46,23,,44.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.44,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,37.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,42.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,102.86,
"FF RESPIR NEBULIZER TREATMENT, INITIAL",25594640,CDM,410,RC,,,outpatient,,,81.25,40.63,,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,55.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,65.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,74.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,77.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,102.86,
Allergy shot-1 shot,25595115,CDM,510,RC,,,outpatient,,,35.75,17.88,,34.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.02,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,102.86,
Multiple allergy shots,25595117,CDM,510,RC,,,outpatient,,,46,23,,44.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,37.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,42.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,102.86,
FF IV INF/HYD INT UP-1HR,25596360,CDM,510,RC,,,outpatient,,,274.75,137.38,,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.28,
FF IV HYD EA ADD HR,25596361,CDM,510,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",25596365,CDM,510,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-additiol infusions",25596366,CDM,510,RC,,,outpatient,,,137.5,68.75,,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.05,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,93.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,110.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,121.84,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,91.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,111.38,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,126.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,130.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,133.38,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,123.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,82.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,123.75,
FF INFUSION SQ MED INITIAL UP TO 1 HR,25596369,CDM,510,RC,,,outpatient,,,307.5,153.75,,298.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,276.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,276.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,223.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,209.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,248.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.21,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,272.48,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,203.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,249.08,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,282.9,92,,,percent of total billed charges,Pays at 92% of total billed charges,292.13,95,,,percent of total billed charges,Pays at 95% of total billed charges,298.28,97,,,percent of total billed charges,Pays at 97% of total billed charges,199.88,65,,,percent of total billed charges,Pays at 65% of total billed charges,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,276.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,184.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,276.75,
FF THER INJ SQ OR IM,25596372,CDM,510,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",25596374,CDM,510,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",25596375,CDM,510,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
FF PORT FLUSH ONLY,25596523,CDM,510,RC,,,outpatient,,,92.5,46.25,,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,63.13,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.67,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,61.33,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,74.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,85.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,87.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,89.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,83.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,55.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.5,102.86,
Eye test,25599173,CDM,510,RC,,,outpatient,,,11,5.5,,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.58,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,102.86,
FF ADVANCE CARE PLAN DURNG AWV 1ST 30 MN,25599497,CDM,510,RC,,,outpatient,,,146.25,73.13,,141.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.27,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,99.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,129.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,96.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,118.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,134.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,138.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,141.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,131.63,
FF ADVANCE CARE PLANNING EA ADDL 30 MIN,25599498,CDM,510,RC,,,outpatient,,,146.25,73.13,,141.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,69.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,99.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,118.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,118.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,129.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,96.96,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,118.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,134.55,92,,,percent of total billed charges,Pays at 92% of total billed charges,138.94,95,,,percent of total billed charges,Pays at 95% of total billed charges,141.86,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.06,65,,,percent of total billed charges,Pays at 65% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,131.63,90,,,percent of total billed charges,Pays at 90% of total billed charges,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,87.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,131.63,
FF PHYSICAL HEARTLAND,25599996,CDM,950,RC,,,outpatient,,,116.75,58.38,,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,84.95,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,79.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,103.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,77.41,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,94.57,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,107.41,92,,,percent of total billed charges,Pays at 92% of total billed charges,110.91,95,,,percent of total billed charges,Pays at 95% of total billed charges,113.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,75.89,65,,,percent of total billed charges,Pays at 65% of total billed charges,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,70.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,105.08,
FF PAP EXAM (MEDICARE INCLUDING BREAST),25599998,CDM,770,RC,,,outpatient,,,84,42,,81.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,75.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,57.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,55.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,68.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,77.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,79.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,81.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.4,90,
Immunization administration by a medical assistant or nurse,25600005,CDM,771,RC,,,outpatient,,,23.75,11.88,,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,102.86,
TK VFC VACCINE ADMINISTRATION EA ADDL,25600006,CDM,771,RC,,,outpatient,,,23.75,11.88,,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,102.86,
Outpatient visit of established patient not requiring a physician,25600011,CDM,510,RC,,,outpatient,,,26.75,13.38,,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,102.86,
Outpatient visit of established patient requiring a physician,25600012,CDM,510,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,102.86,
"Established patient office or other outpatient visit, typically 15 minutes",25600013,CDM,510,RC,,,outpatient,,,40.25,20.13,,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,102.86,
"Established patient office or other outpatient visit, typically 25 minutes",25600014,CDM,510,RC,,,outpatient,,,65.5,32.75,,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,53.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,60.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,62.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,102.86,
"Established patient office or other outpatient, visit typically 40 minutes",25600015,CDM,510,RC,,,outpatient,,,99,49.5,,96.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,80.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,91.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,94.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,96.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,102.86,
TF PFIZER COVID 19 VAC ADMIN 1ST DOSE,25600019,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
Immunization administration by a medical assistant or nurse,25600020,CDM,771,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,102.86,
Immunization administration by a medical assistant or nurse,25600021,CDM,771,RC,,,outpatient,,,28.25,14.13,,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,102.86,
Immunization administration by a medical assistant or nurse,25600022,CDM,771,RC,,,outpatient,,,45.5,22.75,,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,41.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,102.86,
TF PFIZER COVID 19 VAC ADMIN 3RD DOSE,25600025,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
TF PFIZER COVID 19 VAC ADMIN 2ND DOSE,25600029,CDM,771,RC,,,outpatient,,,88.25,44.13,,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,81.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,90,
TF PFIZER COVID 19 VAC ADMIN BOOSTER,25600049,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
TK DIABETES SELF MGMT TRAINING 30 MIN,25600112,CDM,942,RC,,,outpatient,,,44.25,22.13,,42.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.38,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,42.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.55,90,
TF MODER COVID 19 VAC ADMIN 1ST DOSE,25600119,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
TF MODER COVID 19 VAC ADMIN 2ND DOSE,25600129,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
TF MODER COVID 19 VAC ADMIN 3RD DOSE,25600139,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
TF JANSSEN COVID 19 VAC ADMIN,25600319,CDM,771,RC,,,outpatient,,,88.25,44.13,,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,81.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,90,
TF JANSSEN COVID 19 VAC ADMIN BOOSTER,25600349,CDM,771,RC,,,outpatient,,,88.25,44.13,,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,81.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,90,
TF PEDS PFIZER COVID19 VAC ADMIN 1ST DOS,25600719,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
TF PEDS PFIZER COVID19 VAC ADMIN 2ND DOS,25600729,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
TK THER INJ SQ OR IM MOD 59,25606372,CDM,510,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
Flu test,25607804,CDM,300,RC,,,outpatient,,,110.25,55.13,,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,80.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,75.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,73.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.34,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,101.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,104.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,102.86,
TK HBPC REMOVAL IMPACTED CERUM IRRG/LAVA,25609209,CDM,510,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,102.86,
TK REMOVAL IMPACTED CERUMEN IRRIG/LAVAGE,25669209,CDM,510,RC,,,outpatient,,,22.75,11.38,,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,102.86,
Manual urilysis test with examition without using microscope,25681002,CDM,300,RC,,,outpatient,,,20.25,10.13,,19.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.71,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.7,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,18.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.48,102.86,
Urine pregncy test,25681025,CDM,300,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.62,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.61,102.86,
TK OCCULT BLOOD 1-3 TESTS SCREENING,25682270,CDM,300,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.91,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.38,102.86,
TK GLUCOSE WHOLE BLOOD LAB FINGE,25682948,CDM,300,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.8,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.04,102.86,
Blood test to measure levels of hemoglobin,25685018,CDM,300,RC,,,outpatient,,,18.5,9.25,,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.2,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,17.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.37,102.86,
TK TUBERCULIN SKIN TEST (PPD),25686580,CDM,300,RC,,,outpatient,,,12.5,6.25,,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,102.86,
Flu test,25687804,CDM,300,RC,,,outpatient,,,110.25,55.13,,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,80.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,75.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,73.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.34,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,101.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,104.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,102.86,
Test for strep A,25687880,CDM,300,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.32,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.53,102.86,
TF SURGICAL PATHOLOGY III,25688304,CDM,310,RC,,,outpatient,,,64,32,,62.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,46.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,43.68,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,51.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,51.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,56.71,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,51.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,58.88,92,,,percent of total billed charges,Pays at 92% of total billed charges,60.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,62.08,97,,,percent of total billed charges,Pays at 97% of total billed charges,41.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,38.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.4,102.86,
Test of tissues for diagnosis of abnormalities,25688305,CDM,310,RC,,,outpatient,,,202.75,101.38,,196.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,147.52,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,138.38,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,163.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,163.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,179.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,134.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,164.23,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,186.53,92,,,percent of total billed charges,Pays at 92% of total billed charges,192.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,196.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,131.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,182.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,121.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,182.48,
Blood test to assist with diagnosis,25688312,CDM,310,RC,,,outpatient,,,144,72,,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,104.77,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,127.6,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,116.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,132.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,136.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,139.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,93.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,129.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,86.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,129.6,
Pathology test,25688342,CDM,310,RC,,,outpatient,,,149.5,74.75,,145.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.7,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.78,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,102.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.68,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.47,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,99.12,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,121.1,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.54,92,,,percent of total billed charges,Pays at 92% of total billed charges,142.03,95,,,percent of total billed charges,Pays at 95% of total billed charges,145.02,97,,,percent of total billed charges,Pays at 97% of total billed charges,97.18,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.55,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.7,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.55,
Immunization administration by a medical assistant or nurse,25690471,CDM,771,RC,,,outpatient,,,45.5,22.75,,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,41.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,102.86,
TK VACCINE ADMINISTRATION EA ADDL,25690472,CDM,771,RC,,,outpatient,,,23.75,11.88,,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,102.86,
TF FLU MIST ADMINISTRATION/ORAL VACCINE,25690473,CDM,771,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,102.86,
TK EKG TRACING ONLY,25693005,CDM,730,RC,,,outpatient,,,130.75,65.38,,126.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,105.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,120.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,124.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117.68,
"TK RESPIR NEBULIZER TREATMENT, INITIAL",25694640,CDM,410,RC,,,outpatient,,,81.25,40.63,,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,55.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,65.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,74.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,77.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,102.86,
Allergy shot-1 shot,25695115,CDM,510,RC,,,outpatient,,,35.75,17.88,,34.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.02,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,102.86,
Multiple allergy shots,25695117,CDM,510,RC,,,outpatient,,,46,23,,44.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,37.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,42.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,102.86,
TK THER INJ SQ OR IM,25696372,CDM,510,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",25696374,CDM,510,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
TK PAP EXAM (MEDICARE INCLUDING BREAST),25699998,CDM,770,RC,,,outpatient,,,84,42,,81.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,75.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,57.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,55.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,68.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,77.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,79.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,81.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.4,90,
Immunization administration by a medical assistant or nurse,25700005,CDM,771,RC,,,outpatient,,,23.75,11.88,,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,102.86,
MS VFC VACCINE ADMINISTRATION EA ADDL,25700006,CDM,771,RC,,,outpatient,,,23.75,11.88,,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,102.86,
Outpatient visit of established patient not requiring a physician,25700011,CDM,510,RC,,,outpatient,,,26.75,13.38,,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,102.86,
Outpatient visit of established patient requiring a physician,25700012,CDM,510,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,102.86,
"Established patient office or other outpatient visit, typically 15 minutes",25700013,CDM,510,RC,,,outpatient,,,40.25,20.13,,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,102.86,
"Established patient office or other outpatient visit, typically 25 minutes",25700014,CDM,510,RC,,,outpatient,,,65.5,32.75,,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,53.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,60.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,62.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,102.86,
"Established patient office or other outpatient, visit typically 40 minutes",25700015,CDM,510,RC,,,outpatient,,,99,49.5,,96.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,80.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,91.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,94.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,96.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,102.86,
MS PFIZER COVID 19 VAC ADMIN 1ST DOSE,25700019,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
Immunization administration by a medical assistant or nurse,25700020,CDM,771,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,102.86,
Immunization administration by a medical assistant or nurse,25700021,CDM,771,RC,,,outpatient,,,28.25,14.13,,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,102.86,
Immunization administration by a medical assistant or nurse,25700022,CDM,771,RC,,,outpatient,,,45.5,22.75,,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,41.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,102.86,
MS PFIZER COVID 19 VAC ADMIN 3RD DOSE,25700025,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
MS PFIZER COVID 19 VAC ADMIN 2ND DOSE,25700029,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
MS PFIZER COVID 19 VAC ADMIN BOOSTER,25700049,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
MS SCREEN PAP SMEAR OBTAIN PREPARE SEND,25700091,CDM,923,RC,,,outpatient,,,83.25,41.63,,80.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.67,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,74.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,74.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,56.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,49.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,73.77,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,55.19,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,67.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,76.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,79.09,95,,,percent of total billed charges,Pays at 95% of total billed charges,80.75,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.11,65,,,percent of total billed charges,Pays at 65% of total billed charges,49.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,74.93,90,,,percent of total billed charges,Pays at 90% of total billed charges,49.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,49.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,49.95,90,
MS PAP EXAM (MEDICARE INCLUDING BREAST),25700101,CDM,770,RC,,,outpatient,,,84,42,,81.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.34,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,75.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,75.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,57.33,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,74.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,55.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,68.04,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,77.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,79.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,81.48,97,,,percent of total billed charges,Pays at 97% of total billed charges,54.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,75.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,50.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.4,90,
MS DIABETES SELF MGMT TRAINING 30 MIN,25700112,CDM,942,RC,,,outpatient,,,44.25,22.13,,42.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.38,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.2,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.2,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.72,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.21,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.34,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.84,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.71,92,,,percent of total billed charges,Pays at 92% of total billed charges,42.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.92,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,26.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.55,90,
MS MODER COVID 19 VAC ADMIN 1ST DOSE,25700119,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
MS MODER COVID 19 VAC ADMIN 2ND DOSE,25700129,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
MS MODER COVID 19 VAC ADMIN 3RND DOSE,25700139,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
MS JANSSEN COVID 19 VAC ADMIN,25700319,CDM,771,RC,,,outpatient,,,88.25,44.13,,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,81.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,90,
MS COLORECTAL CA SCREEN FECAL OCCULT 1-3,25700328,CDM,770,RC,,,outpatient,,,40.5,20.25,,39.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.08,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,36.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,29.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.64,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,18.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,32.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.69,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.89,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.85,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,24.37,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,37.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.29,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,18.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,36.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,,,,,Other,Not Separately reimbursable,18.05,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.05,100,
MS JANSSEN COVID 19 VAC ADMIN BOOSTER,25700349,CDM,771,RC,,,outpatient,,,88.25,44.13,,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,81.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,90,
MS PEDS PFIZER COVID19 VAC ADMIN 1ST DOS,25700719,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
MS PEDS PFIZER COVID19 VAC ADMIN 2ND DOS,25700729,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
Flu test,25707804,CDM,300,RC,,,outpatient,,,110.25,55.13,,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,80.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,75.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,73.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.34,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,101.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,104.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,102.86,
MS REMOVAL IMPACTED CERUMEN IRRIG/LAVAGE,25769209,CDM,510,RC,,,outpatient,,,22.75,11.38,,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,102.86,
Manual urilysis test with examition without using microscope,25781002,CDM,300,RC,,,outpatient,,,20.25,10.13,,19.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.71,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.7,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,18.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.48,102.86,
Urine pregncy test,25781025,CDM,300,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.62,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.61,102.86,
MS OCCULT BLOOD 1-3 TESTS SCREENING,25782270,CDM,300,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.91,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.38,102.86,
MS GLUCOSE WHOLE BLOOD LAB FINGER,25782948,CDM,300,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.8,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.04,102.86,
Blood test to measure levels of hemoglobin,25785018,CDM,300,RC,,,outpatient,,,18.5,9.25,,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.2,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,17.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.37,102.86,
"Blood test, clotting time",25785610,CDM,300,RC,,,outpatient,,,42.5,21.25,,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.41,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.79,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,39.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.29,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.29,102.86,
MS TUBERCULIN SKIN TEST (PPD),25786580,CDM,300,RC,,,outpatient,,,12.5,6.25,,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,102.86,
Flu test,25787804,CDM,300,RC,,,outpatient,,,110.25,55.13,,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,80.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,75.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,73.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.34,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,101.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,104.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,102.86,
Test for strep A,25787880,CDM,300,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.32,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.53,102.86,
Immunization administration by a medical assistant or nurse,25790471,CDM,771,RC,,,outpatient,,,45.5,22.75,,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,41.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,102.86,
MS VACCINE ADMINISTRATION EA ADDL,25790472,CDM,771,RC,,,outpatient,,,23.75,11.88,,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.17,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.75,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,21.85,92,,,percent of total billed charges,Pays at 92% of total billed charges,22.56,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.44,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.38,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,14.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.25,102.86,
MS FLU MIST ADMINISTRATION/ORAL VACCINE,25790473,CDM,771,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,102.86,
MS EKG TRACING ONLY,25793005,CDM,730,RC,,,outpatient,,,130.75,65.38,,126.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,105.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,120.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,124.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117.68,
MS ANTICOAGULANT MAGMENT,25793792,CDM,510,RC,,,outpatient,,,32.75,16.38,,31.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,31.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,102.86,
MS ANTICOAGULANT MAGEMENT,25793793,CDM,940,RC,,,outpatient,,,32.75,16.38,,31.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.36,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.35,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,26.44,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,21.71,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,26.53,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.11,95,,,percent of total billed charges,Pays at 95% of total billed charges,31.77,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.29,65,,,percent of total billed charges,Pays at 65% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,19.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.65,102.86,
Allergy shot-1 shot,25795115,CDM,510,RC,,,outpatient,,,35.75,17.88,,34.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.02,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,102.86,
Multiple allergy shots,25795117,CDM,510,RC,,,outpatient,,,46,23,,44.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,37.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,42.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,102.86,
TK THER INJ SQ OR IM,25796372,CDM,510,RC,,,outpatient,,,44,22,,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.52,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.99,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,35.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,40.48,92,,,percent of total billed charges,Pays at 92% of total billed charges,41.8,95,,,percent of total billed charges,Pays at 95% of total billed charges,42.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.6,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.6,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.4,102.86,
Prostate cancer screening; digital rectal examition,25799998,CDM,770,RC,,,outpatient,,,34.75,17.38,,33.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.58,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.15,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,31.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,20.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.85,90,
Outpatient visit of established patient not requiring a physician,26000011,CDM,510,RC,,,outpatient,,,26.75,13.38,,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,102.86,
Outpatient visit of established patient requiring a physician,26000012,CDM,510,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,102.86,
"Established patient office or other outpatient visit, typically 15 minutes",26000013,CDM,510,RC,,,outpatient,,,40.25,20.13,,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,102.86,
"Established patient office or other outpatient visit, typically 25 minutes",26000014,CDM,510,RC,,,outpatient,,,65.5,32.75,,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,53.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,60.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,62.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,102.86,
"Established patient office or other outpatient, visit typically 40 minutes",26000015,CDM,510,RC,,,outpatient,,,99,49.5,,96.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,80.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,91.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,94.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,96.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,102.86,
FM PFIZER COVID 19 VAC ADMIN 1ST DOSE,26000019,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
Immunization administration by a medical assistant or nurse,26000020,CDM,771,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,102.86,
Immunization administration by a medical assistant or nurse,26000021,CDM,771,RC,,,outpatient,,,28.25,14.13,,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.28,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.8,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,18.73,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.88,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,25.99,92,,,percent of total billed charges,Pays at 92% of total billed charges,26.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,27.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,18.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,25.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.95,102.86,
Immunization administration by a medical assistant or nurse,26000022,CDM,771,RC,,,outpatient,,,45.5,22.75,,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,41.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,102.86,
FM PFIZER COVID 19 VAC ADMIN 2ND DOSE,26000029,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
FM PFIZER COVID 19 VAC ADMIN BOOSTER,26000049,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
FM MODER COVID 19 VAC ADMIN 1ST DOSE,26000119,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
FM MODER COVID 19 VAC ADMIN 2ND DOSE,26000129,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
FM MODER COVID 19 VAC ADMIN 3RD DOSE,26000139,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
FM JANSSEN COVID 19 VAC ADMIN,26000319,CDM,771,RC,,,outpatient,,,88.25,44.13,,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,81.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,90,
FM JANSSEN COVID 19 VAC ADMIN BOOSTER,26000349,CDM,771,RC,,,outpatient,,,88.25,44.13,,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.48,30,,,percent of total billed charges,Pays at 30% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.21,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,60.23,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,71.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,78.2,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,58.51,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,71.48,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,81.19,92,,,percent of total billed charges,Pays at 92% of total billed charges,83.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,85.6,97,,,percent of total billed charges,Pays at 97% of total billed charges,57.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,52.95,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.95,90,
FM PEDS PFIZER COVID19 VAC ADMIN 1ST DOS,26000719,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
FM PEDS PFIZER COVID19 VAC ADMIN 2ND DOS,26000729,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
meningococcal Meningococcal conjugate vaccine,26000734,CDM,250,RC,,,outpatient,,,244.75,122.38,,237.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,146.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.5,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,220.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,220.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,178.08,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,167.04,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,146.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,197.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,197.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,216.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,162.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,198.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,225.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,232.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,237.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,159.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,146.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,146.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,220.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,146.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,146.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,220.28,
FM PFIZER COVID 19 VAC ADMIN 3RD DOSE,26000925,CDM,771,RC,,,outpatient,,,53,26.5,,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.9,30,,,percent of total billed charges,Pays at 30% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,36.17,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,46.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,35.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,42.93,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,48.76,92,,,percent of total billed charges,Pays at 92% of total billed charges,50.35,95,,,percent of total billed charges,Pays at 95% of total billed charges,51.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,34.45,65,,,percent of total billed charges,Pays at 65% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.7,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,31.8,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,31.8,90,
Flu test,26007804,CDM,300,RC,,,outpatient,,,110.25,55.13,,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,80.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,75.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,73.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.34,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,101.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,104.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,102.86,
FM HBPC REMOVAL IMPACTED CERUM IRRG/LAVA,26009209,CDM,510,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,102.86,
Manual urilysis test with examition without using microscope,26081002,CDM,300,RC,,,outpatient,,,20.25,10.13,,19.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.71,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.7,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,18.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.48,102.86,
Automated urilysis test,26081003,CDM,300,RC,,,outpatient,,,8.25,4.13,,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,1.94,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.04,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,7.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.25,102.86,
Urine pregncy test,26081025,CDM,300,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.62,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.61,102.86,
FM OCCULT BLOOD 1-3 TESTS SCREENING,26082270,CDM,300,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.91,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.38,102.86,
FM OCCULT DIAG BLD POC 1- 3 CARDS,26082272,CDM,300,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.3,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.71,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.23,102.86,
FM GLUCOSE WHOLE BLOOD LAB FINGE,26082948,CDM,300,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.8,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.04,102.86,
Blood test to measure levels of hemoglobin,26085018,CDM,300,RC,,,outpatient,,,18.5,9.25,,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.05,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,12.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,14.93,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.39,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,12.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.2,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,17.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,17.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,17.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,12.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,2.37,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.37,102.86,
FM TUBERCULIN SKIN TEST (PPD),26086580,CDM,300,RC,,,outpatient,,,12.5,6.25,,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,102.86,
A lab test to screen for evidence of vagil infection,26087210,CDM,300,RC,,,outpatient,,,34.75,17.38,,33.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.54,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,25.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,23.72,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,28.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.05,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.04,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.86,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,31.97,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,33.71,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,31.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.82,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.82,102.86,
FM KOH PREP SKIN HAIR ILS,26087220,CDM,300,RC,,,outpatient,,,42.5,21.25,,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.71,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.92,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,29.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,34.31,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.66,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,28.18,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.76,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,39.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,40.38,95,,,percent of total billed charges,Pays at 95% of total billed charges,41.23,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.63,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,38.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.27,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.27,102.86,
Flu test,26087804,CDM,300,RC,,,outpatient,,,110.25,55.13,,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,80.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,75.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,73.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.34,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,101.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,104.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,102.86,
Test for strep A,26087880,CDM,300,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.32,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.53,102.86,
Immunization administration in children <18,26090460,CDM,510,RC,,,outpatient,,,56.5,28.25,,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,38.56,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,45.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,50.06,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,37.46,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,45.77,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,51.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,53.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,54.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,36.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,50.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,33.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.9,102.86,
FM VACCINE COUNSELING < 18 YR ADD'TL,26090461,CDM,510,RC,,,outpatient,,,29.25,14.63,,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,102.86,
Immunization administration by a medical assistant or nurse,26090471,CDM,510,RC,,,outpatient,,,45.5,22.75,,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.05,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.32,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.17,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.86,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,41.86,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.14,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,27.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.3,102.86,
FM VACCINE ADMINISTRATION EA ADDL,26090472,CDM,771,RC,,,outpatient,,,22.75,11.38,,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,15.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,18.36,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.16,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,15.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,18.43,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,21.61,95,,,percent of total billed charges,Pays at 95% of total billed charges,22.07,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.79,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.48,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,13.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.65,102.86,
FM FLU MIST ADMINISTRATION,26090473,CDM,771,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,102.86,
Immunization administered orally or sally,26090474,CDM,771,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,102.86,
meningococcal Meningococcal conjugate vaccine,26090734,CDM,250,RC,,,outpatient,,,0.01,0.01,,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,124.5,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,0.01,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,0.01,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,0.01,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,0.01,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,0.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,0.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,0.01,97,,,percent of total billed charges,Pays at 97% of total billed charges,0.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,90,,,percent of total billed charges,Pays at 90% of total billed charges,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,0.01,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,0.01,102.86,
FM AUDIOMETRY SCREEN TEST PURE TONE AIR,26092551,CDM,471,RC,,,outpatient,,,21.75,10.88,,21.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.14,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,21.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,102.86,
FM EKG TRACING ONLY,26093005,CDM,730,RC,,,outpatient,,,130.75,65.38,,126.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,105.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,120.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,124.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117.68,
"FM RESPIR NEBULIZER TREATMENT, INITIAL",26094640,CDM,410,RC,,,outpatient,,,81.25,40.63,,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,55.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,65.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,74.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,77.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,102.86,
Allergy shot-1 shot,26095115,CDM,510,RC,,,outpatient,,,35.75,17.88,,34.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.02,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.01,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,24.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,28.86,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,31.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,23.7,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,28.96,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,32.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,33.96,95,,,percent of total billed charges,Pays at 95% of total billed charges,34.68,97,,,percent of total billed charges,Pays at 97% of total billed charges,23.24,65,,,percent of total billed charges,Pays at 65% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,21.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.45,102.86,
Multiple allergy shots,26095117,CDM,510,RC,,,outpatient,,,46,23,,44.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,31.4,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,37.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,37.13,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,40.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,30.5,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,37.26,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,42.32,92,,,percent of total billed charges,Pays at 92% of total billed charges,43.7,95,,,percent of total billed charges,Pays at 95% of total billed charges,44.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.9,65,,,percent of total billed charges,Pays at 65% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.4,90,,,percent of total billed charges,Pays at 90% of total billed charges,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,27.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.6,102.86,
FM IV INFUSION INIT 31 MIN TO 1 HR,26096360,CDM,510,RC,,,outpatient,,,119.75,59.88,,116.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,107.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,107.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,87.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,81.73,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,96.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,106.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,79.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,110.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,113.76,95,,,percent of total billed charges,Pays at 95% of total billed charges,116.16,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.84,65,,,percent of total billed charges,Pays at 65% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,107.78,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,71.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,107.78,
FM IM/SQ INJECTIONS OF MEDS,26096372,CDM,510,RC,,,outpatient,,,44.75,22.38,,43.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,40.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,41.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,42.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,43.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.85,102.86,
Eye test,26099173,CDM,510,RC,,,outpatient,,,11,5.5,,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.58,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,7.51,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,8.88,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,9.75,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,7.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,8.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,10.12,92,,,percent of total billed charges,Pays at 92% of total billed charges,10.45,95,,,percent of total billed charges,Pays at 95% of total billed charges,10.67,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.15,65,,,percent of total billed charges,Pays at 65% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.9,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,6.6,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.6,102.86,
UR MINOR PROCEDURE FEE,26500761,CDM,761,RC,,,outpatient,,,517.5,258.75,,501.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,310.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,155.25,30,,,percent of total billed charges,Pays at 30% of total billed charges,465.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,465.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,310.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,376.53,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,353.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,310.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,417.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,417.73,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,458.56,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,343.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,419.18,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,476.1,92,,,percent of total billed charges,Pays at 92% of total billed charges,491.63,95,,,percent of total billed charges,Pays at 95% of total billed charges,501.98,97,,,percent of total billed charges,Pays at 97% of total billed charges,336.38,65,,,percent of total billed charges,Pays at 65% of total billed charges,310.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,310.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,310.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,465.75,90,,,percent of total billed charges,Pays at 90% of total billed charges,310.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,310.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,465.75,
UR HBPC BLADDER IRRIGATION SIMPLE LAVAGE,26501700,CDM,510,RC,,,outpatient,,,190.5,95.25,,184.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,114.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.13,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,171.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,171.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,138.61,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,130.02,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,114.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,153.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,153.77,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,168.8,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,126.3,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,154.31,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,175.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,180.98,95,,,percent of total billed charges,Pays at 95% of total billed charges,184.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,123.83,65,,,percent of total billed charges,Pays at 65% of total billed charges,114.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,171.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,114.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,114.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,171.45,
UR HBPC INSERT NONDWELL BLAD CATHETER,26501701,CDM,510,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.74,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,102.86,
UR HBPC CHANGE CYSTOSTOMY TUBE,26501705,CDM,510,RC,,,outpatient,,,100.5,50.25,,97.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,60.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,90.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,90.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,68.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,60.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,81.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,89.05,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,66.63,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,81.41,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,92.46,92,,,percent of total billed charges,Pays at 92% of total billed charges,95.48,95,,,percent of total billed charges,Pays at 95% of total billed charges,97.49,97,,,percent of total billed charges,Pays at 97% of total billed charges,65.33,65,,,percent of total billed charges,Pays at 65% of total billed charges,60.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.45,90,,,percent of total billed charges,Pays at 90% of total billed charges,60.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,60.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
Procedure on the bladder,26502000,CDM,510,RC,,,outpatient,,,561.5,280.75,,544.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,173.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,505.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,505.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,408.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,383.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,453.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,453.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,497.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,372.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,454.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,516.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,533.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,544.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,364.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,505.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,505.35,
Removal of sperm duct(s),26505250,CDM,510,RC,,,outpatient,,,561.5,280.75,,544.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,345.57,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,505.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,505.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,408.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,383.22,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,453.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,453.24,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,497.55,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,372.27,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,454.82,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,516.58,92,,,percent of total billed charges,Pays at 92% of total billed charges,533.43,95,,,percent of total billed charges,Pays at 95% of total billed charges,544.66,97,,,percent of total billed charges,Pays at 97% of total billed charges,364.98,65,,,percent of total billed charges,Pays at 65% of total billed charges,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,505.35,90,,,percent of total billed charges,Pays at 90% of total billed charges,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,336.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,505.35,
Biopsy of prostate gland,26505700,CDM,510,RC,,,outpatient,,,254.75,127.38,,247.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,152.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,232.32,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,229.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,229.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,185.36,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,173.87,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,152.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,205.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,205.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,225.73,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,168.9,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,206.35,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,234.37,92,,,percent of total billed charges,Pays at 92% of total billed charges,242.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,247.11,97,,,percent of total billed charges,Pays at 97% of total billed charges,165.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,152.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,152.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,229.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,152.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,152.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,229.28,
UR HBPC US GUIDE FOR NEEDLE PLACEMENT,26506942,CDM,402,RC,,,outpatient,,,843.5,421.75,,818.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,506.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.2,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,759.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,759.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,506.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,613.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,575.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,506.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,680.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,680.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,747.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,559.24,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,683.24,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,776.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,801.33,95,,,percent of total billed charges,Pays at 95% of total billed charges,818.2,97,,,percent of total billed charges,Pays at 97% of total billed charges,548.28,65,,,percent of total billed charges,Pays at 65% of total billed charges,506.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,506.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,506.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,759.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,506.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,506.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,759.15,
Manual urilysis test with examition without using microscope,26581002,CDM,300,RC,,,outpatient,,,20.25,10.13,,19.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.71,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,14.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,13.82,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,16.35,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,13.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,4.7,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,18.63,92,,,percent of total billed charges,Pays at 92% of total billed charges,19.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,19.64,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,18.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,3.48,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.48,102.86,
Outpatient visit of established patient not requiring a physician,27000001,CDM,510,RC,,,outpatient,,,26.75,13.38,,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.81,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.46,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,18.26,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.7,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,17.74,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,21.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,24.61,92,,,percent of total billed charges,Pays at 92% of total billed charges,25.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,25.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,16.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,16.05,102.86,
Outpatient visit of established patient requiring a physician,27000002,CDM,510,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,27.14,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,20.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.1,102.86,
"Established patient office or other outpatient visit, typically 15 minutes",27000003,CDM,510,RC,,,outpatient,,,40.25,20.13,,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.12,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,29.29,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,27.47,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,32.49,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,35.67,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,26.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,32.6,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,37.03,92,,,percent of total billed charges,Pays at 92% of total billed charges,38.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,39.04,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,24.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.15,102.86,
"Established patient office or other outpatient visit, typically 25 minutes",27000004,CDM,510,RC,,,outpatient,,,65.5,32.75,,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,98.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,53.06,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,60.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,62.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,39.3,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,39.3,102.86,
"Established patient office or other outpatient, visit typically 40 minutes",27000005,CDM,510,RC,,,outpatient,,,99,49.5,,96.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,132.88,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,72.03,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,67.57,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,79.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,79.91,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,87.72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,65.64,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,80.19,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,91.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,94.05,95,,,percent of total billed charges,Pays at 95% of total billed charges,96.03,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.35,65,,,percent of total billed charges,Pays at 65% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,59.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.4,102.86,
Immunization administration by a medical assistant or nurse,27000471,CDM,771,RC,,,outpatient,,,25,12.5,,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,18.19,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,17.06,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,20.18,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,22.15,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,20.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,23,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,24.25,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15,102.86,
UC PNEUMOVAX VACCINE ADMIN,27000472,CDM,771,RC,,,outpatient,,,24.25,12.13,,23.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,102.86,
Hepatitis A vaccition for adults,27000632,CDM,636,RC,,,outpatient,,,144.75,72.38,,140.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,130.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,130.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.32,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,98.79,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,116.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,116.84,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.26,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,95.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,117.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,133.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,137.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,140.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,94.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,130.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,86.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,130.28,
UC Td TETANUS/DIPTHER(TENIVAC)INJ 0.5ML,27000714,CDM,636,RC,,,outpatient,,,78.75,39.38,,76.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,70.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,70.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,57.3,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,53.75,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,63.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,63.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,69.78,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,52.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,63.79,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,72.45,92,,,percent of total billed charges,Pays at 92% of total billed charges,74.81,95,,,percent of total billed charges,Pays at 95% of total billed charges,76.39,97,,,percent of total billed charges,Pays at 97% of total billed charges,51.19,65,,,percent of total billed charges,Pays at 65% of total billed charges,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,70.88,90,,,percent of total billed charges,Pays at 90% of total billed charges,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,47.25,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.25,102.86,
UC HBPC NEG PRESSURE WOUND THERAPY <= 50,27007605,CDM,510,RC,,,outpatient,,,17.25,8.63,,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.62,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,11.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,13.92,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,15.29,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,11.44,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,13.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,15.87,92,,,percent of total billed charges,Pays at 92% of total billed charges,16.39,95,,,percent of total billed charges,Pays at 95% of total billed charges,16.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,11.21,65,,,percent of total billed charges,Pays at 65% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.53,90,,,percent of total billed charges,Pays at 90% of total billed charges,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,10.35,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.35,102.86,
Flu test,27007804,CDM,300,RC,,,outpatient,,,110.25,55.13,,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,80.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,75.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,73.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.34,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,101.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,104.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,102.86,
UC HBPC REMOVAL IMPACTED CERUM IRRG/LAVA,27009209,CDM,510,RC,,,outpatient,,,9,4.5,,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.55,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,6.14,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.97,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.97,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,7.29,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,8.28,92,,,percent of total billed charges,Pays at 92% of total billed charges,8.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,8.73,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,5.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.4,102.86,
Removal of ear wax from one or both ears,27009210,CDM,510,RC,,,outpatient,,,29.25,14.63,,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,44.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.28,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,19.96,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,23.61,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,25.92,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,19.39,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,23.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,26.91,92,,,percent of total billed charges,Pays at 92% of total billed charges,27.79,95,,,percent of total billed charges,Pays at 95% of total billed charges,28.37,97,,,percent of total billed charges,Pays at 97% of total billed charges,19.01,65,,,percent of total billed charges,Pays at 65% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,17.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.55,102.86,
UC INTRO OF NEEDLE VEIN,27036000,CDM,450,RC,,,outpatient,,,64.75,32.38,,62.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.53,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,47.11,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.19,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,52.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,57.37,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,42.93,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,52.45,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,59.57,92,,,percent of total billed charges,Pays at 92% of total billed charges,61.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,62.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,58.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,38.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.85,102.86,
UC MONO TEST,27076308,CDM,300,RC,,,outpatient,,,65.5,32.75,,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.49,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,47.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,44.7,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,52.87,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,58.04,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,43.43,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.99,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,60.26,92,,,percent of total billed charges,Pays at 92% of total billed charges,62.23,95,,,percent of total billed charges,Pays at 95% of total billed charges,63.54,97,,,percent of total billed charges,Pays at 97% of total billed charges,42.58,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,58.95,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.18,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.18,102.86,
Automated urilysis test,27081003,CDM,300,RC,,,outpatient,,,8.25,4.13,,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,1.94,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.63,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.66,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,7.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.47,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,3.04,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,7.59,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.84,95,,,percent of total billed charges,Pays at 95% of total billed charges,8,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.36,65,,,percent of total billed charges,Pays at 65% of total billed charges,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,7.43,90,,,percent of total billed charges,Pays at 90% of total billed charges,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,2.25,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,2.25,102.86,
Urine pregncy test,27081025,CDM,300,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,6.72,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,11.62,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,8.61,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,8.61,102.86,
UC OCCULT BLOOD 1-3 TESTS SCREENING,27082270,CDM,300,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.42,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.91,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.38,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.38,102.86,
UC OCCULT DIAG BLD POC 1-3 CARDS,27082272,CDM,300,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.3,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.71,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,4.23,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,4.23,102.86,
UC GLUCOSE WHOLE BLOOD LAB FINGE,27082948,CDM,300,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,3.93,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.8,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,5.04,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,5.04,102.86,
UC TUBERCULIN SKIN TEST (PPD),27086580,CDM,300,RC,,,outpatient,,,13.5,6.75,,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,102.86,
Flu test,27087400,CDM,300,RC,,,outpatient,,,110.25,55.13,,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.91,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,80.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,75.25,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,88.99,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,97.69,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,73.1,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.34,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,101.43,92,,,percent of total billed charges,Pays at 92% of total billed charges,104.74,95,,,percent of total billed charges,Pays at 95% of total billed charges,106.94,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.66,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,99.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.55,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.55,102.86,
Test for RSV,27087807,CDM,300,RC,,,outpatient,,,188.5,94.25,,182.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,10.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,169.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,169.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,137.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,128.65,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,152.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,152.16,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,167.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,124.98,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.69,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,173.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,179.08,95,,,percent of total billed charges,Pays at 95% of total billed charges,182.85,97,,,percent of total billed charges,Pays at 97% of total billed charges,122.53,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,169.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,13.1,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,13.1,169.65,
Test for strep A,27087880,CDM,300,RC,,,outpatient,,,33.5,16.75,,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,12.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,24.37,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,22.86,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,27.04,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,29.68,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,22.21,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,22.32,135,,,fee schedule,Pays at 135% of Medicare OPPS rate,30.82,92,,,percent of total billed charges,Pays at 92% of total billed charges,31.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,32.5,97,,,percent of total billed charges,Pays at 97% of total billed charges,21.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,30.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,102.86,100,,,Case rate,pays at 100% of fixed rate,16.53,100,,,fee schedule,Pays at 100% of Medicare OPPS rate,16.53,102.86,
Immunization administration by a medical assistant or nurse,27090471,CDM,771,RC,,,outpatient,,,44.75,22.38,,43.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,40.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,40.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,32.56,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,30.54,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,36.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,36.12,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,39.65,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,29.67,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,36.25,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,41.17,92,,,percent of total billed charges,Pays at 92% of total billed charges,42.51,95,,,percent of total billed charges,Pays at 95% of total billed charges,43.41,97,,,percent of total billed charges,Pays at 97% of total billed charges,29.09,65,,,percent of total billed charges,Pays at 65% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,40.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,26.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,26.85,102.86,
UC VACCINE ADMINISTRATION EA ADDL,27090472,CDM,771,RC,,,outpatient,,,24.25,12.13,,23.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,16.55,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.57,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,21.49,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,16.08,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,19.64,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,22.31,92,,,percent of total billed charges,Pays at 92% of total billed charges,23.04,95,,,percent of total billed charges,Pays at 95% of total billed charges,23.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,15.76,65,,,percent of total billed charges,Pays at 65% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,21.83,90,,,percent of total billed charges,Pays at 90% of total billed charges,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,14.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.55,102.86,
UC PCV 13 PNEUMOCOCCAL (PREVR),27090670,CDM,250,RC,,,outpatient,,,365,182.5,,354.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,219,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,215.33,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,328.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,328.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,219,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,265.57,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,249.11,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,219,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,294.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,294.63,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,323.43,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,242,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,295.65,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,335.8,92,,,percent of total billed charges,Pays at 92% of total billed charges,346.75,95,,,percent of total billed charges,Pays at 95% of total billed charges,354.05,97,,,percent of total billed charges,Pays at 97% of total billed charges,237.25,65,,,percent of total billed charges,Pays at 65% of total billed charges,219,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,219,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,219,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,328.5,90,,,percent of total billed charges,Pays at 90% of total billed charges,219,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,219,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,328.5,
UC TD(TENIVAC) INJ:0.5,27090714,CDM,771,RC,,,outpatient,,,37.75,18.88,,36.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,24.26,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,33.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,33.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,27.47,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,25.76,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,30.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,30.47,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,33.45,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,25.03,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,30.58,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,34.73,92,,,percent of total billed charges,Pays at 92% of total billed charges,35.86,95,,,percent of total billed charges,Pays at 95% of total billed charges,36.62,97,,,percent of total billed charges,Pays at 97% of total billed charges,24.54,65,,,percent of total billed charges,Pays at 65% of total billed charges,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,22.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,22.65,102.86,
"Diphtheria, tetanus acellular, and pertussis vaccine for adults",27090715,CDM,636,RC,,,outpatient,,,380.25,190.13,,368.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,228.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,41.63,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,342.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,342.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,228.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,276.67,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,259.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,228.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,306.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,306.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,336.94,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,252.11,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,308,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,349.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,361.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,368.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,247.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,228.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,228.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,342.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,228.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,228.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,342.23,
pneumococcal Pneumococcal vaccine,27090732,CDM,636,RC,,,outpatient,,,159.25,79.63,,154.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,114.21,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,143.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,143.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,115.87,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,108.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,128.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,128.55,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,141.11,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,105.58,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,128.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,146.51,92,,,percent of total billed charges,Pays at 92% of total billed charges,151.29,95,,,percent of total billed charges,Pays at 95% of total billed charges,154.47,97,,,percent of total billed charges,Pays at 97% of total billed charges,103.51,65,,,percent of total billed charges,Pays at 65% of total billed charges,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,143.33,90,,,percent of total billed charges,Pays at 90% of total billed charges,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,95.55,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,143.33,
UC EKG TRACING ONLY,27093005,CDM,730,RC,,,outpatient,,,130.75,65.38,,126.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.13,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,89.24,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,105.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,115.86,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,86.69,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,105.91,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,120.29,92,,,percent of total billed charges,Pays at 92% of total billed charges,124.21,95,,,percent of total billed charges,Pays at 95% of total billed charges,126.83,97,,,percent of total billed charges,Pays at 97% of total billed charges,84.99,65,,,percent of total billed charges,Pays at 65% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,117.68,90,,,percent of total billed charges,Pays at 90% of total billed charges,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,78.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,117.68,
"UC RESPIR NEBULIZER TREATMENT, INITIAL",27094640,CDM,410,RC,,,outpatient,,,81.25,40.63,,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.59,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,59.12,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,55.45,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,65.59,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,72,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,53.87,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,65.81,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,74.75,92,,,percent of total billed charges,Pays at 92% of total billed charges,77.19,95,,,percent of total billed charges,Pays at 95% of total billed charges,78.81,97,,,percent of total billed charges,Pays at 97% of total billed charges,52.81,65,,,percent of total billed charges,Pays at 65% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,73.13,90,,,percent of total billed charges,Pays at 90% of total billed charges,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,48.75,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,48.75,102.86,
UC IV INF/HYD INT UP-1HR,27096360,CDM,510,RC,,,outpatient,,,274.75,137.38,,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,33.56,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,199.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,187.52,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,221.78,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,243.46,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,182.16,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,222.55,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,252.77,92,,,percent of total billed charges,Pays at 92% of total billed charges,261.01,95,,,percent of total billed charges,Pays at 95% of total billed charges,266.51,97,,,percent of total billed charges,Pays at 97% of total billed charges,178.59,65,,,percent of total billed charges,Pays at 65% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,247.28,90,,,percent of total billed charges,Pays at 90% of total billed charges,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,164.85,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,247.28,
UC IV HYD EA ADD HR,27096361,CDM,510,RC,,,outpatient,,,107,53.5,,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.11,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,77.85,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,73.03,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,86.37,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,94.81,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,70.94,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,86.67,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,98.44,92,,,percent of total billed charges,Pays at 92% of total billed charges,101.65,95,,,percent of total billed charges,Pays at 95% of total billed charges,103.79,97,,,percent of total billed charges,Pays at 97% of total billed charges,69.55,65,,,percent of total billed charges,Pays at 65% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,96.3,90,,,percent of total billed charges,Pays at 90% of total billed charges,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,64.2,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion",27096365,CDM,510,RC,,,outpatient,,,280.25,140.13,,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,62.82,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,203.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,191.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,226.22,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,248.33,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,185.81,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,227,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,257.83,92,,,percent of total billed charges,Pays at 92% of total billed charges,266.24,95,,,percent of total billed charges,Pays at 95% of total billed charges,271.84,97,,,percent of total billed charges,Pays at 97% of total billed charges,182.16,65,,,percent of total billed charges,Pays at 65% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,252.23,90,,,percent of total billed charges,Pays at 90% of total billed charges,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,168.15,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,252.23,
UC THER INJ SQ OR IM,27096372,CDM,510,RC,,,outpatient,,,47.75,23.88,,46.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.24,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,42.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,42.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.74,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,32.59,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,38.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,38.54,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,42.31,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,31.66,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,38.68,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,43.93,92,,,percent of total billed charges,Pays at 92% of total billed charges,45.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,46.32,97,,,percent of total billed charges,Pays at 97% of total billed charges,31.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,42.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,28.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,28.65,102.86,
"Intravenous infusion, for therapy, prophylaxis, or diagnosis-IV push",27096374,CDM,510,RC,,,outpatient,,,149,74.5,,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,34.51,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,108.41,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,101.69,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,120.27,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,132.03,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,98.79,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,120.69,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,137.08,92,,,percent of total billed charges,Pays at 92% of total billed charges,141.55,95,,,percent of total billed charges,Pays at 95% of total billed charges,144.53,97,,,percent of total billed charges,Pays at 97% of total billed charges,96.85,65,,,percent of total billed charges,Pays at 65% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,134.1,90,,,percent of total billed charges,Pays at 90% of total billed charges,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,89.4,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,134.1,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on",27096375,CDM,510,RC,,,outpatient,,,111.75,55.88,,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,14.89,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,81.31,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,76.27,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,90.2,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,99.02,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,74.09,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,90.52,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,102.81,92,,,percent of total billed charges,Pays at 92% of total billed charges,106.16,95,,,percent of total billed charges,Pays at 95% of total billed charges,108.4,97,,,percent of total billed charges,Pays at 97% of total billed charges,72.64,65,,,percent of total billed charges,Pays at 65% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,100.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,67.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,102.86,
"Intravenous infusion, for treatment, prophylaxis, or diagnosis-same drug add on",27096376,CDM,450,RC,,,outpatient,,,76.5,38.25,,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.39,100,,,fee schedule,Pays at 100% of Aet Market Fee Schedule,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.66,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,52.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,61.75,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,67.79,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,50.72,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,61.97,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,70.38,92,,,percent of total billed charges,Pays at 92% of total billed charges,72.68,95,,,percent of total billed charges,Pays at 95% of total billed charges,74.21,97,,,percent of total billed charges,Pays at 97% of total billed charges,49.73,65,,,percent of total billed charges,Pays at 65% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,68.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,102.86,100,,,Case rate,pays at 100% of fixed rate,45.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,45.9,102.86,
PT VISIT 1-15,30000003,CDM,421,RC,,,outpatient,,,185.75,92.88,,180.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,111.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,55.73,30,,,percent of total billed charges,Pays at 30% of total billed charges,167.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,167.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,135.15,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,126.77,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,111.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,149.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,149.94,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,164.59,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,123.15,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,150.46,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,170.89,92,,,percent of total billed charges,Pays at 92% of total billed charges,176.46,95,,,percent of total billed charges,Pays at 95% of total billed charges,180.18,97,,,percent of total billed charges,Pays at 97% of total billed charges,120.74,65,,,percent of total billed charges,Pays at 65% of total billed charges,111.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,111.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,167.18,90,,,percent of total billed charges,Pays at 90% of total billed charges,111.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,111.45,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,167.18,
SAF-CLENS,30000274,CDM,272,RC,,,outpatient,,,21.75,10.88,,21.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.53,30,,,percent of total billed charges,Pays at 30% of total billed charges,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,15.83,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,14.84,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,17.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,17.56,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,19.27,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,14.42,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,17.62,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,20.01,92,,,percent of total billed charges,Pays at 92% of total billed charges,20.66,95,,,percent of total billed charges,Pays at 95% of total billed charges,21.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,14.14,65,,,percent of total billed charges,Pays at 65% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,19.58,90,,,percent of total billed charges,Pays at 90% of total billed charges,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,13.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,13.05,90,
PAK ABLATION VEIN,80035021,CDM,272,RC,,,outpatient,,,118.5,59.25,,114.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,71.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,35.55,30,,,percent of total billed charges,Pays at 30% of total billed charges,106.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,106.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,86.22,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,80.88,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,71.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,95.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,95.65,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,105,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,78.57,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,95.99,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,109.02,92,,,percent of total billed charges,Pays at 92% of total billed charges,112.58,95,,,percent of total billed charges,Pays at 95% of total billed charges,114.95,97,,,percent of total billed charges,Pays at 97% of total billed charges,77.03,65,,,percent of total billed charges,Pays at 65% of total billed charges,71.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,71.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,106.65,90,,,percent of total billed charges,Pays at 90% of total billed charges,71.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,71.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,60,106.65,
BLOOD PRESSURE CUFF PED,80044539,CDM,272,RC,,,outpatient,,,6.75,3.38,,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.03,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.91,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.61,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.45,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.98,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.48,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.47,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,6.21,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.41,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.55,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.39,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.08,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.05,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,90,
BLOOD PRESSURE CUFF SM ADULT,80044540,CDM,272,RC,,,outpatient,,,6.5,3.25,,6.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,1.95,30,,,percent of total billed charges,Pays at 30% of total billed charges,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.73,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,4.44,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.25,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,5.76,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,4.31,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,5.27,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,5.98,92,,,percent of total billed charges,Pays at 92% of total billed charges,6.18,95,,,percent of total billed charges,Pays at 95% of total billed charges,6.31,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.23,65,,,percent of total billed charges,Pays at 65% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.85,90,,,percent of total billed charges,Pays at 90% of total billed charges,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,3.9,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.9,90,
BLOOD PRESSURE CUFFLG ADULT,80044541,CDM,272,RC,,,outpatient,,,7.75,3.88,,7.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.65,90,
BLOOD PRESSURE CUFF LG ADULT,80044542,CDM,272,RC,,,outpatient,,,7.75,3.88,,7.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,4.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,2.33,30,,,percent of total billed charges,Pays at 30% of total billed charges,6.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,6.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,5.64,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,5.29,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,4.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.26,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,6.87,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,5.14,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,6.28,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,7.13,92,,,percent of total billed charges,Pays at 92% of total billed charges,7.36,95,,,percent of total billed charges,Pays at 95% of total billed charges,7.52,97,,,percent of total billed charges,Pays at 97% of total billed charges,5.04,65,,,percent of total billed charges,Pays at 65% of total billed charges,4.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,6.98,90,,,percent of total billed charges,Pays at 90% of total billed charges,4.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,4.65,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.65,90,
BLOOD PRESSURE CUFF ADULT BARI,80044543,CDM,272,RC,,,outpatient,,,12.5,6.25,,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,3.75,30,,,percent of total billed charges,Pays at 30% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.1,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,8.53,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.09,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.08,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.29,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.13,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,11.5,92,,,percent of total billed charges,Pays at 92% of total billed charges,11.88,95,,,percent of total billed charges,Pays at 95% of total billed charges,12.13,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.13,65,,,percent of total billed charges,Pays at 65% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,11.25,90,,,percent of total billed charges,Pays at 90% of total billed charges,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,7.5,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,7.5,90,
BLOOD PRESSURE CUFF LONG  ADULT,80044544,CDM,272,RC,,,outpatient,,,13.5,6.75,,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,4.05,30,,,percent of total billed charges,Pays at 30% of total billed charges,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,9.82,72.76,,,percent of total billed charges,Pays at 72.76% of total billed charges,9.21,68.25,,,percent of total billed charges,Pays at 68.25% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,10.9,80.72,,,percent of total billed charges,Pays at 80.72% of total billed charges,11.96,88.61,,,percent of total billed charges,Pays at 88.61% of total billed charges,8.95,66.3,,,percent of total billed charges,Pays at 66.30% of total billed charges,10.94,81,,,percent of total billed charges,81% of total billed charges for outpatient setting,12.42,92,,,percent of total billed charges,Pays at 92% of total billed charges,12.83,95,,,percent of total billed charges,Pays at 95% of total billed charges,13.1,97,,,percent of total billed charges,Pays at 97% of total billed charges,8.78,65,,,percent of total billed charges,Pays at 65% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,12.15,90,,,percent of total billed charges,Pays at 90% of total billed charges,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,,,,,Other,Not Separately reimbursable,8.1,60,,,percent of total billed charges,60% of total billed charges for outpatient setting,8.1,90,
.DIFF PATH REVIEW- ALL INCLUSIVE BILLING,1000604,CDM,971,RC,,,outpatient,,,18.5,9.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Test to measure arterial blood gases,1094700,CDM,969,RC,82803,HCPCS,outpatient,,,363.75,181.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Test to measure arterial blood gases,1094705,CDM,969,RC,82803,HCPCS,outpatient,,,607.75,303.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Hepatitis A vaccition for adults,3003573,CDM,982,RC,90632,HCPCS,outpatient,,,144.75,72.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF VFC HIB PRPT(HIBERIX):0.5 ML,3012448,CDM,983,RC,90648,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Hepatitis A vaccition for adults,3013458,CDM,982,RC,90632,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Hepatitis A vaccition for adults,3017350,CDM,982,RC,90632,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
COVID-19 VACC DOSE 1 PFIZER 30MCG/0.3ML,3017842,CDM,969,RC,91300,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
COVID-19 VACC DOSE 2 PFIZER 30MCG/0.3ML,3017843,CDM,969,RC,91300,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
COVID-19 VACC DOSE 1 MODER100MCG/0.5ML,3017845,CDM,969,RC,91301,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
COVID-19 VACC DOSE 2 MODER100MCG/0.5ML,3017846,CDM,969,RC,91301,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
COVID-19 JANSSEN 1 FIRST DOSE VACC 0.5ML,3018222,CDM,969,RC,91303,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
COVID-19 VACC DOSE 3 PFIZER 30MCG/0.3ML,3019309,CDM,969,RC,91300,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
COVID-19 VACC DOSE 3 MODER50MCG/0.25ML,3019310,CDM,969,RC,91301,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
COVID-19 JANSSEN 2 BOOSTER VACC 0.5ML,3019630,CDM,969,RC,91303,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
COVID-19 *PEDS DOSE 1 PFIZER 10MCG/0.2ML,3019631,CDM,969,RC,91307,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
COVID-19 *PEDS DOSE 2 PFIZER 10MCG/0.2ML,3019632,CDM,969,RC,91307,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
EKG INTERP,4009018,CDM,985,RC,93010,HCPCS,outpatient,,,63.75,31.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
XR SWALLOW EVAL,4500010,CDM,969,RC,92611,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Single view,4571010,CDM,969,RC,71045,HCPCS,outpatient,,,194.25,97.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
AEROSOL TREATMENT SUBS RESP,5000004,CDM,969,RC,94640,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MDI SUBS RESP,5000023,CDM,969,RC,94640,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Routine EKG using at least 12 leads including interpretation and report,5093000,CDM,969,RC,93000,HCPCS,outpatient,,,138.75,69.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Test to determine how well oxygen moves from the lungs to the blood stream,5094010,CDM,969,RC,94010,HCPCS,outpatient,,,389.25,194.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Test to determine if wheezing is present,5094060,CDM,969,RC,94060,HCPCS,outpatient,,,581,290.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
DL BLACK LUNG EXAM & HANDLING,5099456,CDM,969,RC,99456,HCPCS,outpatient,,,650.25,325.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Hepatitis A vaccition for adults,6000034,CDM,982,RC,90632,HCPCS,outpatient,,,88.75,44.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Hepatitis B vaccine,6000036,CDM,982,RC,90746,HCPCS,outpatient,,,76.5,38.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
LHI AIRBORNE EXAM,6000042,CDM,982,RC,,,outpatient,,,85,42.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
LHI PHA,6000044,CDM,982,RC,99201,HCPCS,outpatient,,,45,22.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
LHI HEP B PEDIATRIC INCLUDES ADMIN,6000046,CDM,982,RC,,,outpatient,,,37.9,18.95,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Collection of venous blood by venipuncture,6000048,CDM,982,RC,36415,HCPCS,outpatient,,,3.75,1.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Collection of venous blood by venipuncture,6000049,CDM,982,RC,36415,HCPCS,outpatient,,,10,5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 10 minutes",6000050,CDM,982,RC,99202,HCPCS,outpatient,,,60,30,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
LHI VARICELLA INCLUDING INJECTION,6000051,CDM,982,RC,,,outpatient,,,136.5,68.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
LHI MMR INCLUDING INJECTION,6000052,CDM,982,RC,,,outpatient,,,40.25,20.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MUSCULOSKELETAL EXAM,6001070,CDM,983,RC,95812,HCPCS,outpatient,,,43.5,21.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
COORDITION FEE,6001180,CDM,983,RC,,,outpatient,,,18.75,9.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
COORDITION FEE BL,6001186,CDM,983,RC,,,outpatient,,,18.75,9.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CLIENT SET UP,6001187,CDM,983,RC,,,outpatient,,,70,35,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
B READING PRO FEE,6001188,CDM,972,RC,,,outpatient,,,70,35,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Hepatitis B vaccine,6001506,CDM,982,RC,90746,HCPCS,outpatient,,,76.5,38.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Hepatitis A vaccition for adults,6001508,CDM,982,RC,90632,HCPCS,outpatient,,,131.75,65.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OHS LHI APPOINTMENT CANCELLATION/NO SHOW,6099456,CDM,982,RC,99456,HCPCS,outpatient,,,20,10,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of ear wax from one or both ears,13469210,CDM,983,RC,69210,HCPCS,outpatient,,,108.75,54.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
RP INITIAL HOSPITAL CARE HIGH COMPLEX,13499223,CDM,983,RC,99223,HCPCS,outpatient,,,674,337,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
RP SUBS HOSPITAL CARE LOW COMPLEXITY,13499231,CDM,983,RC,99231,HCPCS,outpatient,,,127.5,63.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
RP SUBS HOSPITAL CARE MOD COMPLEXITY,13499232,CDM,983,RC,99232,HCPCS,outpatient,,,235,117.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
RP SUBS HOSPITAL CARE HIGH,13499233,CDM,983,RC,99233,HCPCS,outpatient,,,346.5,173.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
RP HOSPITAL DISCHARGE >30 MIN,13499239,CDM,983,RC,99239,HCPCS,outpatient,,,360.5,180.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
RP CRITICAL CARE,13499291,CDM,983,RC,99291,HCPCS,outpatient,,,689,344.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
RP INIT NURSING FACILITY CARE/DAY MOD,13499305,CDM,983,RC,99305,HCPCS,outpatient,,,289.25,144.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
RP INITIAL NRS FAC HIGH COMPLEX,13499306,CDM,983,RC,99306,HCPCS,outpatient,,,559.75,279.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
RP SUBS NRS FACILITY CARE LOW COMPLEX,13499308,CDM,983,RC,99308,HCPCS,outpatient,,,232.5,116.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
RP SUBS NRSING FACILITY CARE PER DAY MOD,13499309,CDM,983,RC,99309,HCPCS,outpatient,,,308.25,154.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
RP SUBS NRSING FACILITY CARE HIGH COMPLE,13499310,CDM,983,RC,99310,HCPCS,outpatient,,,456.25,228.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
RP NRSING FACILITY DISCH DAY 30 MIN OR <,13499315,CDM,983,RC,99315,HCPCS,outpatient,,,247.5,123.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
RP NRSING FACILITY DISCHARGE DAY >30 MIN,13499316,CDM,983,RC,99316,HCPCS,outpatient,,,355.25,177.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
POLYSOMNOGRAPHY <6 YRS > 4 PAR ATTEN PRO,14605782,CDM,983,RC,95782,HCPCS,outpatient,,,400.75,200.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SLEEP STUDY UTTEND PRO,14605800,CDM,985,RC,95800,HCPCS,outpatient,,,174.25,87.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SLEEP STUDY UTTEND MINIMUM PRO,14605801,CDM,985,RC,95801,HCPCS,outpatient,,,155.25,77.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
POLYSOMNOGRAPHY MULT SLEEP LAT TE MSLT P,14605805,CDM,986,RC,95805,HCPCS,outpatient,,,227.75,113.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
HOME SLEEP STUDY PRO,14605806,CDM,986,RC,95806,HCPCS,outpatient,,,177.5,88.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Sleep monitoring of patient (6 years or older) in sleep lab,14605810,CDM,986,RC,95810,HCPCS,outpatient,,,421.25,210.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Sleep monitoring of patient (6 years or older) in sleep lab using CPAP,14605811,CDM,986,RC,95811,HCPCS,outpatient,,,451.5,225.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 5-10 minutes of medical discussion",14608441,CDM,983,RC,99441,HCPCS,outpatient,,,58.75,29.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 11-20 minutes of medical discussion",14608442,CDM,983,RC,99442,HCPCS,outpatient,,,106.5,53.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 21-30 minutes of medical discussion",14608443,CDM,983,RC,99443,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 10 minutes",14608902,CDM,983,RC,99202,HCPCS,outpatient,,,106.75,53.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 45 min",14608904,CDM,983,RC,99204,HCPCS,outpatient,,,265,132.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient requiring a physician,14608912,CDM,983,RC,99212,HCPCS,outpatient,,,56.5,28.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",14608913,CDM,983,RC,99213,HCPCS,outpatient,,,106,53,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 25 minutes",14608914,CDM,983,RC,99214,HCPCS,outpatient,,,157.5,78.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient not requiring a physician,14609211,CDM,983,RC,99211,HCPCS,outpatient,,,24.25,12.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient requiring a physician,14609212,CDM,983,RC,99212,HCPCS,outpatient,,,56.5,28.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",14609213,CDM,983,RC,99213,HCPCS,outpatient,,,106,53,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 25 minutes",14609214,CDM,983,RC,99214,HCPCS,outpatient,,,163,81.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient, visit typically 40 minutes",14609215,CDM,983,RC,99215,HCPCS,outpatient,,,231.5,115.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
EEG W/O VIDEO PRO 2-12 HR CONTINUOUS,14695717,CDM,986,RC,95717,HCPCS,outpatient,,,213.75,106.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
EEG W VIDEO PRO (VEEG)2-12 HR CONTINUOUS,14695718,CDM,986,RC,95718,HCPCS,outpatient,,,281,140.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SLEEP STUDY ATTENDED >= 6HRS PRO,14695807,CDM,986,RC,95807,HCPCS,outpatient,,,143.5,71.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SC EEG 41-60 MINUTES PRO,14695812,CDM,986,RC,95812,HCPCS,outpatient,,,140.75,70.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SC EEG 61-119 MINUTES PRO,14695813,CDM,986,RC,95813,HCPCS,outpatient,,,326.75,163.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SC EEG AWAKE DROWSY PRO,14695816,CDM,986,RC,95816,HCPCS,outpatient,,,257,128.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SC EEG AWAKE ASLEEP PRO,14695819,CDM,986,RC,95819,HCPCS,outpatient,,,492,246,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 10 minutes",14699202,CDM,983,RC,99202,HCPCS,outpatient,,,106.75,53.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 30 min",14699203,CDM,983,RC,99203,HCPCS,outpatient,,,161.75,80.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 45 min",14699204,CDM,983,RC,99204,HCPCS,outpatient,,,268.5,134.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 60 min",14699205,CDM,983,RC,99205,HCPCS,outpatient,,,349.25,174.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SMOKING CESSATION COUNSELING 3 TO 10 MIN,14699406,CDM,983,RC,99406,HCPCS,outpatient,,,27.25,13.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SMOKING CESSATION COUNSELING OVER 10 MIN,14699407,CDM,983,RC,99407,HCPCS,outpatient,,,54.25,27.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Separation and removal of the entire il plate or a portion of il plate,15200002,CDM,981,RC,11730,HCPCS,outpatient,,,284.75,142.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
EVAC SUB HEMATOMA,15200003,CDM,981,RC,11740,HCPCS,outpatient,,,149,74.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Simple repair of superficial wounds of scalp, neck, axillae, exterl genitalia, trunk and/or extremities",15200004,CDM,981,RC,12001,HCPCS,outpatient,,,369,184.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SIMP WOUND 2.6 - 7.5,15200005,CDM,981,RC,12002,HCPCS,outpatient,,,439,219.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SIMP WOUND 7.6-12.5,15200006,CDM,981,RC,12004,HCPCS,outpatient,,,539,269.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SIMP WOUND 12.6 - 20,15200007,CDM,981,RC,12005,HCPCS,outpatient,,,678.25,339.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SIMP WOUND 20.1 - 30,15200008,CDM,981,RC,12006,HCPCS,outpatient,,,842.75,421.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SIMPLE WOUND > 30.0,15200009,CDM,981,RC,12007,HCPCS,outpatient,,,936.75,468.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SIMP WOUND 2.6 - 5.0,15200010,CDM,981,RC,12013,HCPCS,outpatient,,,504.25,252.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SIMP WOUND 5.1 - 7.5,15200011,CDM,981,RC,12014,HCPCS,outpatient,,,589.25,294.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SIMP WOUND 7.6 -12.5,15200012,CDM,981,RC,12015,HCPCS,outpatient,,,789,394.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SIMP WOUND 12.6 - 20,15200013,CDM,981,RC,12016,HCPCS,outpatient,,,802.75,401.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SIMP WOUND 20.1 - 30,15200014,CDM,981,RC,12017,HCPCS,outpatient,,,811.25,405.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SIMP WOUND >30,15200015,CDM,981,RC,12018,HCPCS,outpatient,,,1015.25,507.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
LAYER WOUND 2.5,15200016,CDM,981,RC,12031,HCPCS,outpatient,,,652.25,326.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
LAYR WOUND 2.6 - 7.5,15200017,CDM,981,RC,12032,HCPCS,outpatient,,,827.75,413.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
LAY WOUND 7.6 - 12.5,15200018,CDM,981,RC,12034,HCPCS,outpatient,,,833.75,416.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
LAY WOUND 12.6 - 20.,15200019,CDM,981,RC,12035,HCPCS,outpatient,,,1022.75,511.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
LAYER WOUND 2.5,15200022,CDM,981,RC,12041,HCPCS,outpatient,,,516,258,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
LAY WOUND 2.6 - 7.5,15200023,CDM,981,RC,12042,HCPCS,outpatient,,,606,303,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
LAY WOUND 7.6 - 12.5,15200024,CDM,981,RC,12044,HCPCS,outpatient,,,808,404,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
LAY WOUND 12.6 - 20.,15200025,CDM,981,RC,12045,HCPCS,outpatient,,,920.5,460.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
LAY WOUND 20.1 - 30.,15200026,CDM,981,RC,12046,HCPCS,outpatient,,,1230.75,615.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
LAYER WOUND 2.5,15200028,CDM,981,RC,12051,HCPCS,outpatient,,,735.25,367.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
LAY WOUND 2.6 - 5.0,15200029,CDM,981,RC,12052,HCPCS,outpatient,,,827.75,413.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
LAY WOUND 5.1 - 7.5,15200030,CDM,981,RC,12053,HCPCS,outpatient,,,914.75,457.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
LAY WOUND 7.6 - 12.5,15200031,CDM,981,RC,12054,HCPCS,outpatient,,,1104.75,552.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
LAY WOUND 12.6 - 20.,15200032,CDM,981,RC,12055,HCPCS,outpatient,,,1189.5,594.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
BURN INT 1ST DEGREE,15200035,CDM,981,RC,16000,HCPCS,outpatient,,,187.5,93.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
DRESS/DEBR BURN SMALL,15200036,CDM,981,RC,16020,HCPCS,outpatient,,,199,99.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
DRESS/DEBR BURN MED,15200037,CDM,981,RC,16025,HCPCS,outpatient,,,426.25,213.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
DRESS/DEBR BURN LG,15200038,CDM,981,RC,16030,HCPCS,outpatient,,,507.25,253.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
RML FOR BDY MUS SIMP,15200041,CDM,981,RC,20520,HCPCS,outpatient,,,561,280.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Injection of medication into a tendon or ligament,15200042,CDM,981,RC,20550,HCPCS,outpatient,,,217,108.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a small joint/bursa without ultrasound,15200043,CDM,981,RC,20600,HCPCS,outpatient,,,190,95,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a large joint/bursa without ultrasound,15200044,CDM,981,RC,20605,HCPCS,outpatient,,,211,105.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a major joint/bursa without ultrasound,15200045,CDM,981,RC,20610,HCPCS,outpatient,,,257,128.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CL TEMPOROMAND,15200047,CDM,981,RC,21480,HCPCS,outpatient,,,291.5,145.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CL ACROMIOCLAV DISCL,15200051,CDM,981,RC,23540,HCPCS,outpatient,,,729.75,364.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CL SHOULDER DISLOC,15200052,CDM,981,RC,23650,HCPCS,outpatient,,,955.5,477.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CLD RAD HEAD SUBL CHD,15200053,CDM,981,RC,24640,HCPCS,outpatient,,,423,211.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INCI/DRAIN DEEP ABSC,15200054,CDM,981,RC,25028,HCPCS,outpatient,,,1769.25,884.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
DRAIGE FINGER ABSC,15200057,CDM,981,RC,26010,HCPCS,outpatient,,,587,293.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TREAT CL DIS PHAL FR,15200059,CDM,981,RC,26750,HCPCS,outpatient,,,553,276.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OPEN DIS PHAL FRAC,15200060,CDM,981,RC,26765,HCPCS,outpatient,,,1559.75,779.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CL IN/PHAL JNT DIS,15200061,CDM,981,RC,26770,HCPCS,outpatient,,,729,364.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TRT CL PATELLAR DISL,15200062,CDM,981,RC,27560,HCPCS,outpatient,,,1006.75,503.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
APPL LONG ARM SPLINT,15200063,CDM,981,RC,29105,HCPCS,outpatient,,,262.5,131.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
APPL SHORT ARM SPLIN,15200064,CDM,981,RC,29125,HCPCS,outpatient,,,195.5,97.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
APPL FINGER SPLINT,15200065,CDM,981,RC,29130,HCPCS,outpatient,,,124.75,62.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
STRAPPING /SHOULDER,15200066,CDM,981,RC,29240,HCPCS,outpatient,,,169.5,84.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
APPL LONG LEG SPLINT,15200067,CDM,981,RC,29505,HCPCS,outpatient,,,271.5,135.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
APPL SHORT LEG SPLIN,15200068,CDM,981,RC,29515,HCPCS,outpatient,,,213.25,106.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
STRAPPING ANKLE/FOOT,15200070,CDM,981,RC,29540,HCPCS,outpatient,,,124.5,62.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
RMV/BIVALV /GAUNTLET,15200071,CDM,981,RC,29700,HCPCS,outpatient,,,179.75,89.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
REMOV FOR BODY SAL,15200072,CDM,981,RC,30300,HCPCS,outpatient,,,585.75,292.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SAL HEMOR /ANTER SIMPLE UNILATERAL,15200073,CDM,981,RC,30901,HCPCS,outpatient,,,332.25,166.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SAL HEMOR /UNILAT COMPLEX,15200074,CDM,981,RC,30903,HCPCS,outpatient,,,527.5,263.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SAL HEMOR /POSTERI,15200076,CDM,981,RC,30905,HCPCS,outpatient,,,787.75,393.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SAL HEMOR /SUBSEQNT,15200077,CDM,981,RC,30906,HCPCS,outpatient,,,760,380,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INTUBATION ENDOTREAC,15200078,CDM,981,RC,31500,HCPCS,outpatient,,,266,133,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
LARYNGOSC DIR ASPRI,15200081,CDM,981,RC,31515,HCPCS,outpatient,,,865.5,432.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
LARYNGOSC W FOR BODY,15200082,CDM,981,RC,31530,HCPCS,outpatient,,,1669.75,834.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TUBE THORACOSTOMY BILATERAL,15200084,CDM,981,RC,32551,HCPCS,outpatient,,,594.75,297.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
NEEDLE INTRACATH VE,15200088,CDM,981,RC,36000,HCPCS,outpatient,,,122,61,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CATH SUP/INF VE C,15200090,CDM,981,RC,36010,HCPCS,outpatient,,,1792.75,896.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
VE PU<AGE 3 FE/JU/SA,15200091,CDM,981,RC,36400,HCPCS,outpatient,,,57.25,28.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
VE PU<AGE 3 SCAL VE,15200092,CDM,981,RC,36405,HCPCS,outpatient,,,128.5,64.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
VE PU>AGE 3 MD SKILL,15200093,CDM,981,RC,36410,HCPCS,outpatient,,,62.25,31.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
VE PUNC CUTDWN<AGE 1,15200095,CDM,981,RC,36420,HCPCS,outpatient,,,185.25,92.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
VE PUNC CUTDWN>AGE 1,15200096,CDM,981,RC,36425,HCPCS,outpatient,,,83.75,41.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ART PUNC W/DRAW BLOD,15200099,CDM,981,RC,36600,HCPCS,outpatient,,,120.5,60.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ART CATH/CANN /SAMP,15200100,CDM,981,RC,36620,HCPCS,outpatient,,,123.25,61.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ART CATH /CUTDOWN,15200101,CDM,981,RC,36625,HCPCS,outpatient,,,646.75,323.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
RPR LAC 2.5 LESS MOU,15200104,CDM,981,RC,41250,HCPCS,outpatient,,,620.25,310.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
RPR TNG LAC MOU FL,15200106,CDM,981,RC,41252,HCPCS,outpatient,,,855,427.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INCI/DRA PERIAL AB,15200108,CDM,981,RC,46050,HCPCS,outpatient,,,476,238,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INCI THROMB HEMORRHD,15200109,CDM,981,RC,46083,HCPCS,outpatient,,,464.75,232.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ENUC/EXCI EXT THROMB,15200110,CDM,981,RC,46320,HCPCS,outpatient,,,475,237.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INCI/DR ABS VULVA EX,15200114,CDM,981,RC,56405,HCPCS,outpatient,,,479.25,239.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INCI/DR BATHOLINS GL,15200115,CDM,981,RC,56420,HCPCS,outpatient,,,472.5,236.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Vagil delivery,15200117,CDM,981,RC,59409,HCPCS,outpatient,,,2963.5,1481.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SPINL PUNC LUMB DIAG,15200118,CDM,981,RC,62270,HCPCS,outpatient,,,316.5,158.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
RMV FOR BODY EXT EYE,15200119,CDM,981,RC,65205,HCPCS,outpatient,,,261.25,130.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
RMV FOR BDY CONJ EMB,15200120,CDM,981,RC,65210,HCPCS,outpatient,,,322.5,161.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
RMV FOR BODY CORNEAL,15200121,CDM,981,RC,65220,HCPCS,outpatient,,,266,133,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
RMV FOR BDY EX AUDI,15200122,CDM,981,RC,69200,HCPCS,outpatient,,,246,123,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of ear wax from one or both ears,15200123,CDM,981,RC,69210,HCPCS,outpatient,,,138.75,69.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CPR,15200140,CDM,981,RC,92950,HCPCS,outpatient,,,854.75,427.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CARDIOVERS ELECT EXT,15200141,CDM,981,RC,92960,HCPCS,outpatient,,,735,367.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
EKG INTERPRET & REPORT,15200142,CDM,981,RC,93010,HCPCS,outpatient,,,62.25,31.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
RHYTM ECG INTERP&REP,15200143,CDM,981,RC,93042,HCPCS,outpatient,,,32,16,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
THER INJ SQ OR IM,15200144,CDM,981,RC,96372,HCPCS,outpatient,,,44,22,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ER PAT /LOW,15200148,CDM,981,RC,99282,HCPCS,outpatient,,,183.75,91.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, moderately severe problem",15200149,CDM,981,RC,99283,HCPCS,outpatient,,,267.25,133.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem of high severity",15200150,CDM,981,RC,99284,HCPCS,outpatient,,,420,210,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem with significant threat to life or function",15200151,CDM,981,RC,99285,HCPCS,outpatient,,,633.5,316.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
REPAIR IL BED,15200152,CDM,981,RC,11760,HCPCS,outpatient,,,668.25,334.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ER SCREEN MINIMAL,15200153,CDM,981,RC,99281,HCPCS,outpatient,,,120.5,60.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ER SCREEN MINIMAL,15200154,CDM,981,RC,99281,HCPCS,outpatient,,,120.5,60.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
DEBRID OF ILS,15200161,CDM,981,RC,11720,HCPCS,outpatient,,,90,45,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CLD TRT METAFRAX W/O,15200162,CDM,981,RC,28470,HCPCS,outpatient,,,815.25,407.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CLD TRT FRAX TOE,15200163,CDM,981,RC,28490,HCPCS,outpatient,,,451.75,225.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CLD TRT FRAX PHAL W/O,15200164,CDM,981,RC,28510,HCPCS,outpatient,,,405,202.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
APP SHORT LEG CAST,15200165,CDM,981,RC,29405,HCPCS,outpatient,,,363.25,181.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
STRAPPING-UN BOOT,15200166,CDM,981,RC,29580,HCPCS,outpatient,,,172.5,86.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Incision and draige of abscess; simple or single and complex or multiple,15200171,CDM,981,RC,10060,HCPCS,outpatient,,,274.75,137.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INC/DRAIN ABSCESS /COMP,15200172,CDM,981,RC,10061,HCPCS,outpatient,,,544.25,272.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INC/DRN PILON CYST SIMP,15200173,CDM,981,RC,10080,HCPCS,outpatient,,,352,176,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INC/REM FOREIGN BDY /SIMP,15200174,CDM,981,RC,10120,HCPCS,outpatient,,,284.75,142.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INC/REM FORG BDY /COMPLEX,15200175,CDM,981,RC,10121,HCPCS,outpatient,,,659.5,329.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Incision and draige of hematoma, seroma or fluid collection",15200176,CDM,981,RC,10140,HCPCS,outpatient,,,325.75,162.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Puncture aspiration of abscess, hematoma, bulla, or cyst",15200177,CDM,981,RC,10160,HCPCS,outpatient,,,274.75,137.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INC/DRAIN COMPLEX POSTOP,15200178,CDM,981,RC,10180,HCPCS,outpatient,,,704.75,352.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
DEBRIDE SKIN /SUB TISSUE,15200180,CDM,981,RC,11042,HCPCS,outpatient,,,133.5,66.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
EXCISION OF IL,15200182,CDM,981,RC,11750,HCPCS,outpatient,,,636.75,318.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
WEDGE EXCISION SKIN,15200183,CDM,981,RC,11765,HCPCS,outpatient,,,344.25,172.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes",15200184,CDM,981,RC,12011,HCPCS,outpatient,,,425.75,212.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TRT SUPERFICIAL /SIMPLE,15200185,CDM,981,RC,12020,HCPCS,outpatient,,,750,375,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TRT SUPERFICIAL W/PACK,15200186,CDM,981,RC,12021,HCPCS,outpatient,,,456.25,228.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
REP /COMPLEX TRNK 2.6-7.5,15200188,CDM,981,RC,13101,HCPCS,outpatient,,,948.75,474.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
REPAIR /COMPLEX 2.6-7.5,15200190,CDM,981,RC,13121,HCPCS,outpatient,,,1217,608.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
REPAIR /COMPLEX 1.1-2.5,15200191,CDM,981,RC,13131,HCPCS,outpatient,,,1042.25,521.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
REPAIR /COMPLEX 2.6-7.5,15200192,CDM,981,RC,13132,HCPCS,outpatient,,,1609.5,804.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
REPAIR /COMPLEX 2.6-7.5,15200195,CDM,981,RC,13152,HCPCS,outpatient,,,1776.5,888.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INFECTED BURSA,15200204,CDM,981,RC,23931,HCPCS,outpatient,,,880.75,440.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
AMPUTATION /FINGER /THUMB,15200206,CDM,981,RC,26951,HCPCS,outpatient,,,1958,979,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
REM FORG BODY FOOT SUB,15200209,CDM,981,RC,28190,HCPCS,outpatient,,,666.5,333.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
APP CAST LONG ARM,15200210,CDM,981,RC,29065,HCPCS,outpatient,,,360,180,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
APP CAST SHORT ARM,15200211,CDM,981,RC,29075,HCPCS,outpatient,,,300.25,150.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
APP CAST GUANTLET,15200212,CDM,981,RC,29085,HCPCS,outpatient,,,315.25,157.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
STRAPPING THORAX,15200213,CDM,981,RC,29200,HCPCS,outpatient,,,122,61,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
APP CAST THIGH TO ANKLE,15200216,CDM,981,RC,29365,HCPCS,outpatient,,,434.25,217.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
APP CAST SHORT LEG AMB,15200217,CDM,981,RC,29425,HCPCS,outpatient,,,405,202.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ADD WALKER,15200218,CDM,981,RC,29440,HCPCS,outpatient,,,150.75,75.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
REM/REP FULL ARM/LEG CST,15200219,CDM,981,RC,29705,HCPCS,outpatient,,,226.25,113.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INCISION TRACH EM,15200222,CDM,981,RC,31603,HCPCS,outpatient,,,725.5,362.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INCISION CRICOTHYROID,15200223,CDM,981,RC,31605,HCPCS,outpatient,,,604.5,302.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
VENIPUNCTURE /OTHER VEIN,15200225,CDM,981,RC,36406,HCPCS,outpatient,,,91.5,45.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
PLC NEEDLE INTRAOSSEOUS,15200227,CDM,981,RC,36680,HCPCS,outpatient,,,185.25,92.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
REPAIR LIP FULL,15200228,CDM,981,RC,40650,HCPCS,outpatient,,,1351.75,675.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
BLADDER IRRIGATION,15200238,CDM,981,RC,51700,HCPCS,outpatient,,,315.25,157.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
DRAIGE OF SCROTAL WALL,15200240,CDM,981,RC,55100,HCPCS,outpatient,,,779.25,389.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
REMOVAL FORG BODY EYELID,15200243,CDM,981,RC,67938,HCPCS,outpatient,,,607.75,303.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
DRAIN EXTERL EAR /SIMP,15200244,CDM,981,RC,69000,HCPCS,outpatient,,,493.5,246.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ER PAT /LOW,15200248,CDM,981,RC,99282,HCPCS,outpatient,,,183.75,91.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, moderately severe problem",15200249,CDM,981,RC,99283,HCPCS,outpatient,,,267.25,133.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TEMP TRANSCUTANEOUS PCNG,15200252,CDM,981,RC,92953,HCPCS,outpatient,,,128.5,64.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
THROMBOLYSIS BY IV,15200253,CDM,981,RC,92977,HCPCS,outpatient,,,1430.75,715.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CRIT CARE EVAL&MGMT 1 HR,15200255,CDM,981,RC,99291,HCPCS,outpatient,,,725,362.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CRIT CARE MGMT EA 30 MIN,15200256,CDM,981,RC,99292,HCPCS,outpatient,,,385,192.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CLD SHLD DISLOC W/ANES,15200258,CDM,981,RC,23655,HCPCS,outpatient,,,1333,666.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INJ FACIAL NERVE,15200259,CDM,981,RC,64402,HCPCS,outpatient,,,374.5,187.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
PARING BENIGN LESION,15200264,CDM,981,RC,11055,HCPCS,outpatient,,,135.75,67.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
PROLONG SERVICE,15200266,CDM,981,RC,99354,HCPCS,outpatient,,,293.75,146.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
PROLONG SERVICE,15200268,CDM,981,RC,99355,HCPCS,outpatient,,,229,114.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
PROLONG SERVICE,15200270,CDM,981,RC,99356,HCPCS,outpatient,,,327,163.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
PROLONG SERVICE,15200272,CDM,981,RC,99357,HCPCS,outpatient,,,261.25,130.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
PROLONG SERVICE,15200274,CDM,981,RC,99358,HCPCS,outpatient,,,288.75,144.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
PROLONG SERVICE,15200276,CDM,981,RC,99359,HCPCS,outpatient,,,173.75,86.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
REPAIR CPLX EA ADD 5CM,15200280,CDM,981,RC,13122,HCPCS,outpatient,,,434.25,217.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
REPAIR CPLX EA ADD 5CM,15200282,CDM,981,RC,13133,HCPCS,outpatient,,,606,303,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Removal of skin tags, multiple fibrocutaneous tags, any area",15200286,CDM,981,RC,11200,HCPCS,outpatient,,,225.25,112.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CLSD FX DIST RAD W/MANIP,15200288,CDM,981,RC,25605,HCPCS,outpatient,,,1742.75,871.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CLD TRT FX VICULAR,15200292,CDM,981,RC,25622,HCPCS,outpatient,,,802.75,401.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CLD TRT FX RAD/UL W/O,15200294,CDM,981,RC,25560,HCPCS,outpatient,,,718.75,359.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SAL HEMOR / BILATERAL COMPLEX,15200296,CDM,981,RC,30903,HCPCS,outpatient,,,770.25,385.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CLD TRMT FX DISTAL FIB,15200298,CDM,981,RC,27786,HCPCS,outpatient,,,856.25,428.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CL TRMT FX DIST RAD W/O,15200300,CDM,981,RC,25600,HCPCS,outpatient,,,786.5,393.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CLD TRMT METACARP FX,15200302,CDM,981,RC,26600,HCPCS,outpatient,,,740.25,370.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CL TRT DIS FING W/O ANES,15200303,CDM,981,RC,26700,HCPCS,outpatient,,,863.25,431.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TRT METACARPAL FX,15200304,CDM,981,RC,26605,HCPCS,outpatient,,,1135,567.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
APPLY FINGER SPLINT,15200306,CDM,981,RC,29131,HCPCS,outpatient,,,138.25,69.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TRT THUMB DISLOCATION,15200308,CDM,981,RC,26641,HCPCS,outpatient,,,1154.5,577.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
EXPLORE WOUND EXTERLLY,15200312,CDM,981,RC,20103,HCPCS,outpatient,,,1588.5,794.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CATH INDWELLING COMPLEX,15200316,CDM,981,RC,51703,HCPCS,outpatient,,,450,225,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CATH INDWELLING SIMPLE,15200318,CDM,981,RC,51702,HCPCS,outpatient,,,287,143.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of fluid or injection of medication into a ganglion cyst,15200322,CDM,981,RC,20612,HCPCS,outpatient,,,220.75,110.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TRT FX UL,15200328,CDM,981,RC,25530,HCPCS,outpatient,,,938.5,469.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TRIM ILS,15200330,CDM,981,RC,11719,HCPCS,outpatient,,,60.75,30.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient requiring a physician,15200332,CDM,981,RC,99212,HCPCS,outpatient,,,97,48.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of infected skin,15200334,CDM,981,RC,11000,HCPCS,outpatient,,,178.75,89.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TRT FX RADIUS/UL,15200336,CDM,981,RC,25606,HCPCS,outpatient,,,2794.5,1397.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CLSD TRT SAL FX,15200338,CDM,981,RC,21315,HCPCS,outpatient,,,775.75,387.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
LARYNOGOSCOPY /DIAG,15200342,CDM,981,RC,31525,HCPCS,outpatient,,,1261.5,630.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CLSD TRT PHAL SHAFT,15200344,CDM,981,RC,26720,HCPCS,outpatient,,,593.5,296.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Fine Needle Aspiration Biopsy without imaging,15200348,CDM,981,RC,10021,HCPCS,outpatient,,,393.5,196.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
EXCISION BEN LES .5,15200350,CDM,981,RC,11420,HCPCS,outpatient,,,319.75,159.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SUTURE GUM,15200356,CDM,981,RC,41899,HCPCS,outpatient,,,313.75,156.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TREAT TOE FX,15200358,CDM,981,RC,28515,HCPCS,outpatient,,,527.75,263.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TRT FX RADIUS & UL,15200384,CDM,981,RC,25565,HCPCS,outpatient,,,1486,743,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TRT HUMERUS FRACTURE,15200385,CDM,981,RC,24577,HCPCS,outpatient,,,1514.5,757.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"TRT FINGER FRACTURE, EACH",15200388,CDM,981,RC,26742,HCPCS,outpatient,,,1032.25,516.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TELEHEALTH CONS STROKE ED/IP APPROX 30 M,15200425,CDM,988,RC,G0425,HCPCS,outpatient,,,326.25,163.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
DRAIN EYELID ABCESS,15200430,CDM,981,RC,67700,HCPCS,outpatient,,,663.25,331.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
NERVE BLOCK INJ,15200434,CDM,981,RC,64405,HCPCS,outpatient,,,457.75,228.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
NERVE BLOCK /OTHER,15200436,CDM,981,RC,64450,HCPCS,outpatient,,,308,154,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TRT RADIUS FX,15200440,CDM,981,RC,24655,HCPCS,outpatient,,,1214,607,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TRT THUMB FX,15200442,CDM,981,RC,26645,HCPCS,outpatient,,,1321,660.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem of high severity",15200450,CDM,981,RC,99284,HCPCS,outpatient,,,420,210,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem with significant threat to life or function",15200451,CDM,981,RC,99285,HCPCS,outpatient,,,633.5,316.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"TRT CLSD ELBOW DISLOCATION, NO ANESTH",15200453,CDM,981,RC,24600,HCPCS,outpatient,,,1045,522.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CLSD TX BIMALLEOLAR FX MAN,15200455,CDM,981,RC,27810,HCPCS,outpatient,,,1350.25,675.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TRT FINGER FX,15200470,CDM,981,RC,26725,HCPCS,outpatient,,,938.25,469.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
DRAIN MOUTH LESION,15200472,CDM,981,RC,40800,HCPCS,outpatient,,,535.75,267.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TUBE THORACOSTOMY LT,15200476,CDM,981,RC,32551,HCPCS,outpatient,,,1149.75,574.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TUBE THORACOSTOMY RT,15200477,CDM,981,RC,32551,HCPCS,outpatient,,,1149.75,574.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
DECLOTTING THROMB CATH,15200478,CDM,981,RC,36593,HCPCS,outpatient,,,135.75,67.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
DRAIGE ABSCESS DENTOALVEOLAR STRUCTURE,15200480,CDM,981,RC,41800,HCPCS,outpatient,,,596.75,298.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INCISE RECTAL ABSCESS,15200506,CDM,981,RC,46040,HCPCS,outpatient,,,1387,693.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TREAT TOE DISLOCATION,15200881,CDM,981,RC,28660,HCPCS,outpatient,,,370.5,185.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INSERT NON-TUNNEL CV CATH,15200883,CDM,981,RC,36556,HCPCS,outpatient,,,702,351,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
EO SAL HEMOR /ANTER SIMPLE,15200901,CDM,982,RC,30901,HCPCS,outpatient,,,332.25,166.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"INJ TRIGGER POINT, 1/2 MUSCLE",15201073,CDM,981,RC,20552,HCPCS,outpatient,,,222.5,111.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",15201075,CDM,981,RC,99213,HCPCS,outpatient,,,153,76.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GLOBAL SURGICAL CARE,15201077,CDM,969,RC,99024,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SIALOLITHOTOMY,15201079,CDM,981,RC,42330,HCPCS,outpatient,,,646.5,323.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Injection of medication into the tendon/ligament origin,15201080,CDM,981,RC,20551,HCPCS,outpatient,,,225.25,112.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TRT HIP DISLOCATION,15201082,CDM,981,RC,27250,HCPCS,outpatient,,,748.75,374.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INCISE BREAST LESION,15201084,CDM,981,RC,19020,HCPCS,outpatient,,,1198.5,599.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ADJUST GASTRIC BAND DIAMETER VIA SUBCUTA,15202083,CDM,981,RC,S2083,HCPCS,outpatient,,,139.5,69.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INC & DRAIN PILONIDAL CYST COMPLICATED,15210081,CDM,981,RC,10081,HCPCS,outpatient,,,449.75,224.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Paring or cutting of benign hyperkeratotic lesion,15211056,CDM,981,RC,11056,HCPCS,outpatient,,,167,83.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ED INCISIOL BX SKIN SINGLE LESION,15211106,CDM,983,RC,11106,HCPCS,outpatient,,,144,72,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Injection of medication into an area that triggers pain,15220553,CDM,981,RC,20553,HCPCS,outpatient,,,112.75,56.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
HUMERAL NECK FRACTURE,15223600,CDM,981,RC,23600,HCPCS,outpatient,,,710.75,355.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CLSD TRT SHOULDER DISLOCATION ANES,15223665,CDM,981,RC,23665,HCPCS,outpatient,,,1240.75,620.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ED REMOVAL FB UPPER ARM/ELBOW DEEP,15224201,CDM,981,RC,24201,HCPCS,outpatient,,,983.25,491.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CLSD TX DIST RADIOULR W/MANIP,15225675,CDM,981,RC,25675,HCPCS,outpatient,,,990.25,495.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CL TX DISTAL PHAL FX FINGER/THUMB W MANI,15226755,CDM,981,RC,26755,HCPCS,outpatient,,,713.75,356.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ED CLSD TRT TIBIAL SHAFT W MANIP,15227752,CDM,983,RC,27752,HCPCS,outpatient,,,2024.75,1012.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ED CLOSED TX DISTAL FIB FX W/MANIP,15227788,CDM,981,RC,27788,HCPCS,outpatient,,,945.75,472.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ED CL TX FX DISTAL TIBIA W/SKELETAL TRAC,15227825,CDM,981,RC,27825,HCPCS,outpatient,,,1256.5,628.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CLOSED TRT ANKLE DISLOCATION W/O ANESTHE,15227840,CDM,981,RC,27840,HCPCS,outpatient,,,886,443,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TX TARSAL BONE FX W MANIP EA,15228455,CDM,981,RC,28455,HCPCS,outpatient,,,826.75,413.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CL TX METATARSOPHAL JT DISLOCAT W/O ANES,15228630,CDM,981,RC,28630,HCPCS,outpatient,,,287.25,143.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CONTROL SAL BLEED ANTERIOR SIMPL BILAT,15230901,CDM,981,RC,30901,HCPCS,outpatient,,,359.25,179.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ED INSERTION PERIPHERAL CENTRAL VAD WO I,15236569,CDM,983,RC,36569,HCPCS,outpatient,,,309.25,154.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GASTRIC INTUBATION ASPIR THERAPEUTIC,15243753,CDM,981,RC,43753,HCPCS,outpatient,,,63.5,31.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ED REPLACEMENT GASTROSTOMY TUBE,15243762,CDM,980,RC,43762,HCPCS,outpatient,,,69.25,34.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
DESTRUCTION LESION PENIS SIMPLE SURGICAL,15254060,CDM,981,RC,54060,HCPCS,outpatient,,,579.25,289.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INCISION AND DRAIN EPIDIDYMIS,15254700,CDM,981,RC,54700,HCPCS,outpatient,,,707.5,353.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
VAGIL PACKING FOR HEMORRHAGE,15257180,CDM,981,RC,57180,HCPCS,outpatient,,,426.25,213.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SPIL TAP THERAPEUTIC DRAIN SPIL FLUI,15262272,CDM,981,RC,62272,HCPCS,outpatient,,,189.75,94.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INJ TRIGEMIL NERVE,15264400,CDM,981,RC,64400,HCPCS,outpatient,,,154,77,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INJ ANESTHETIC AGENT/STEROID,15264455,CDM,981,RC,64455,HCPCS,outpatient,,,164,82,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
REMOVAL FB EXTERL EYE CORNEA SLIT LAMP,15265222,CDM,981,RC,65222,HCPCS,outpatient,,,146.25,73.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
REMOVAL IMPACTED CERUMEN IRRIG/LAVAG,15269209,CDM,981,RC,69209,HCPCS,outpatient,,,22.75,11.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Debridement (for example, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps)",15297597,CDM,981,RC,97597,HCPCS,outpatient,,,217,108.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MOD SEDATION INITIAL 15 MIN <5 YRS AGE,15299151,CDM,981,RC,99151,HCPCS,outpatient,,,83,41.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MOD SEDATION INITIAL 15 MIN 5 OR > YRS A,15299152,CDM,981,RC,99152,HCPCS,outpatient,,,43,21.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MOD SEDATION EACH ADDTL 15 MIN,15299153,CDM,981,RC,99153,HCPCS,outpatient,,,33.5,16.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ED MODERATE SEDATION OTHER THAN PROVIDER,15299156,CDM,983,RC,99156,HCPCS,outpatient,,,127,63.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ED OBSERVATION DISCHARGE,15299217,CDM,982,RC,99217,HCPCS,outpatient,,,173.5,86.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ED INITIALOBS CARE LOW SEVERITY,15299218,CDM,982,RC,99218,HCPCS,outpatient,,,165.25,82.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ED OBSERVATION CARE INITIAL MODERATE,15299219,CDM,983,RC,99219,HCPCS,outpatient,,,270.75,135.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OBSERVATION CARE INITIAL HIGH,15299220,CDM,983,RC,99220,HCPCS,outpatient,,,377.5,188.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ED SUBSEQUENT OBSERV CARE PROB FOC,15299224,CDM,982,RC,99224,HCPCS,outpatient,,,78.75,39.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"SUBSEQ HOSPITAL CARE, EXP PROB",15299232,CDM,981,RC,99232,HCPCS,outpatient,,,172.5,86.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ED OBS IP ADMIT DISC SAME DAY LOW,15299234,CDM,981,RC,99234,HCPCS,outpatient,,,329.75,164.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ED OBS IP ADMIT DISC SAME DAY MODERATE,15299235,CDM,981,RC,99235,HCPCS,outpatient,,,432,216,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ED OBS IP ADMIT DISC SAME DAY HIGH,15299236,CDM,981,RC,99236,HCPCS,outpatient,,,542.25,271.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
NURSING FACILITY CARE SUBSEQUENT,15299308,CDM,983,RC,99308,HCPCS,outpatient,,,158.25,79.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 10 minutes",19500004,CDM,983,RC,99202,HCPCS,outpatient,,,106.5,53.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 30 min",19500006,CDM,983,RC,99203,HCPCS,outpatient,,,161.75,80.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 45 min",19500008,CDM,983,RC,99204,HCPCS,outpatient,,,268.75,134.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 60 min",19500010,CDM,983,RC,99205,HCPCS,outpatient,,,349.5,174.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient not requiring a physician,19500022,CDM,983,RC,99211,HCPCS,outpatient,,,21.25,10.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient requiring a physician,19500024,CDM,983,RC,99212,HCPCS,outpatient,,,54.75,27.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",19500026,CDM,983,RC,99213,HCPCS,outpatient,,,105.75,52.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 25 minutes",19500028,CDM,983,RC,99214,HCPCS,outpatient,,,163.25,81.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient, visit typically 40 minutes",19500030,CDM,983,RC,99215,HCPCS,outpatient,,,231.5,115.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ER SCREEN MINIMAL,19500081,CDM,981,RC,99281,HCPCS,outpatient,,,54.5,27.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ER PAT /LOW,19500082,CDM,981,RC,99282,HCPCS,outpatient,,,106,53,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, moderately severe problem",19500083,CDM,981,RC,99283,HCPCS,outpatient,,,166,83,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem of high severity",19500084,CDM,981,RC,99284,HCPCS,outpatient,,,307.75,153.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem with significant threat to life or function",19500085,CDM,981,RC,99285,HCPCS,outpatient,,,458.25,229.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
EEG AWAKE DROWSY PRO,19500102,CDM,986,RC,95816,HCPCS,outpatient,,,257,128.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
EEG AWAKE ASLEEP PRO,19500104,CDM,986,RC,95819,HCPCS,outpatient,,,492,246,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
EEG 41-60 MINUTES PRO,19500106,CDM,986,RC,95812,HCPCS,outpatient,,,141,70.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
EEG OVER 1 HR PRO,19500108,CDM,986,RC,95813,HCPCS,outpatient,,,327,163.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Injection of medication into a tendon or ligament,19500142,CDM,983,RC,20550,HCPCS,outpatient,,,85.75,42.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INJECTION CARPAL TUNNEL,19500144,CDM,983,RC,20526,HCPCS,outpatient,,,163.5,81.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Injection of medication into the tendon/ligament origin,19500146,CDM,983,RC,20551,HCPCS,outpatient,,,122.5,61.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TRIGGER PT INJ MUS C-2,19500148,CDM,983,RC,20552,HCPCS,outpatient,,,102.75,51.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Injection of medication into an area that triggers pain,19500150,CDM,983,RC,20553,HCPCS,outpatient,,,112.75,56.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a small joint/bursa without ultrasound,19500152,CDM,983,RC,20600,HCPCS,outpatient,,,85.5,42.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a large joint/bursa without ultrasound,19500154,CDM,983,RC,20605,HCPCS,outpatient,,,92.75,46.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a major joint/bursa without ultrasound,19500156,CDM,983,RC,20610,HCPCS,outpatient,,,112.75,56.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
NR COUNSELING LUNG CANCER SCREEN LDCT,19500296,CDM,983,RC,G0296,HCPCS,outpatient,,,49.75,24.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SPIL T/L DIAG,19500340,CDM,983,RC,62270,HCPCS,outpatient,,,316.5,158.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance,19500540,CDM,983,RC,64483,HCPCS,outpatient,,,1017,508.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
HOSPITAL ADMISSION 1,19503000,CDM,983,RC,99221,HCPCS,outpatient,,,237.75,118.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
HOSPITAL ADMISSION 2,19503002,CDM,983,RC,99222,HCPCS,outpatient,,,324,162,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
HOSPITAL ADMISSION 3,19503004,CDM,983,RC,99223,HCPCS,outpatient,,,475.75,237.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SUBSEQ HOSPITAL 1,19503100,CDM,983,RC,99231,HCPCS,outpatient,,,98.25,49.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SUBSEQ HOSPITAL 2,19503102,CDM,983,RC,99232,HCPCS,outpatient,,,176.25,88.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SUBSEQ HOSPITAL 3,19503104,CDM,983,RC,99233,HCPCS,outpatient,,,252,126,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OBS/HOSP SAME DATE 1,19503200,CDM,983,RC,99234,HCPCS,outpatient,,,336.5,168.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OBS/HOSP SAME DATE 2,19503202,CDM,983,RC,99235,HCPCS,outpatient,,,441.25,220.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OBS/HOSP SAME DATE 3,19503204,CDM,983,RC,99236,HCPCS,outpatient,,,548,274,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
HOSPITAL D/C DAY MGMT 30 MIN OR LESS,19503300,CDM,983,RC,99238,HCPCS,outpatient,,,173.75,86.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
HOSPITAL DISCH DAY MGMT MORE THAN 30 MIN,19503302,CDM,983,RC,99239,HCPCS,outpatient,,,252.5,126.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 5-10 minutes of medical discussion",19508441,CDM,983,RC,99441,HCPCS,outpatient,,,58.75,29.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 11-20 minutes of medical discussion",19508442,CDM,983,RC,99442,HCPCS,outpatient,,,106.75,53.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 21-30 minutes of medical discussion",19508443,CDM,983,RC,99443,HCPCS,outpatient,,,162,81,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 10 minutes",19508902,CDM,983,RC,99202,HCPCS,outpatient,,,107,53.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 30 min",19508903,CDM,983,RC,99203,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 45 min",19508904,CDM,983,RC,99204,HCPCS,outpatient,,,265,132.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 60 min",19508905,CDM,983,RC,99205,HCPCS,outpatient,,,343.5,171.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient not requiring a physician,19508911,CDM,983,RC,99211,HCPCS,outpatient,,,26.75,13.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient requiring a physician,19508912,CDM,983,RC,99212,HCPCS,outpatient,,,58.75,29.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",19508913,CDM,983,RC,99213,HCPCS,outpatient,,,106.75,53.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 25 minutes",19508914,CDM,983,RC,99214,HCPCS,outpatient,,,162,81,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient, visit typically 40 minutes",19508915,CDM,983,RC,99215,HCPCS,outpatient,,,229.25,114.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ER SCREEN MINIMAL,19509281,CDM,981,RC,99281,HCPCS,outpatient,,,53.5,26.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ER PAT /LOW,19509282,CDM,981,RC,99282,HCPCS,outpatient,,,104.5,52.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, moderately severe problem",19509283,CDM,981,RC,99283,HCPCS,outpatient,,,166,83,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem of high severity",19509284,CDM,981,RC,99284,HCPCS,outpatient,,,307.75,153.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem with significant threat to life or function",19509285,CDM,981,RC,99285,HCPCS,outpatient,,,458.25,229.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Puncture aspiration of abscess, hematoma, bulla, or cyst",19510160,CDM,983,RC,10160,HCPCS,outpatient,,,249.5,124.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of fluid or injection of medication into a ganglion cyst,19520612,CDM,983,RC,20612,HCPCS,outpatient,,,123.75,61.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
HOSPITAL ADMISSION 1,19540100,CDM,983,RC,99221,HCPCS,outpatient,,,237.75,118.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
HOSPITAL ADMISSION 2,19540102,CDM,983,RC,99222,HCPCS,outpatient,,,324,162,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
HOSPITAL ADMISSION 3,19540104,CDM,983,RC,99223,HCPCS,outpatient,,,475.75,237.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SUBSEQ HOSPITAL 1,19540106,CDM,983,RC,99231,HCPCS,outpatient,,,98.25,49.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SUBSEQ HOSPITAL 2,19540108,CDM,983,RC,99232,HCPCS,outpatient,,,176.25,88.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SUBSEQ HOSPITAL 3,19540110,CDM,983,RC,99233,HCPCS,outpatient,,,252,126,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OBS/HOSP SAME DATE 1,19540112,CDM,983,RC,99234,HCPCS,outpatient,,,336.5,168.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OBS/HOSP SAME DATE 2,19540114,CDM,983,RC,99235,HCPCS,outpatient,,,441.25,220.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OBS/HOSP SAME DATE 3,19540116,CDM,983,RC,99236,HCPCS,outpatient,,,548,274,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
HOSPITAL D/C DAY 30 MIN OR LESS,19540118,CDM,983,RC,99238,HCPCS,outpatient,,,173.75,86.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
HOSPITAL D/C DAY MORE THAN 30 MIN,19540120,CDM,983,RC,99239,HCPCS,outpatient,,,252.5,126.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OBSERVATION DISCHARGE,19540122,CDM,983,RC,99217,HCPCS,outpatient,,,174.75,87.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OBSERVATION CARE INITIAL LOW 25,19540124,CDM,983,RC,99218,HCPCS,outpatient,,,166.5,83.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OBSERVATION CARE INITIAL MODERATE,19540126,CDM,983,RC,99219,HCPCS,outpatient,,,275.5,137.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OBSERVATION CARE INITIAL HIGH,19540128,CDM,983,RC,99220,HCPCS,outpatient,,,379.75,189.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a small joint/bursa without ultrasound,19550600,CDM,983,RC,20600,HCPCS,outpatient,,,171,85.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SPIL TAP THERAPEUTIC,19562272,CDM,983,RC,62272,HCPCS,outpatient,,,316.5,158.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Injection of substance into spil cal of lower back or sacrum using imaging guidance,19562322,CDM,983,RC,62322,HCPCS,outpatient,,,175,87.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INJECTION ANESTHETIC AGENT FEMORAL NERVE,19564447,CDM,983,RC,64447,HCPCS,outpatient,,,197.25,98.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
NR EEG W/O VIDEO PRO 2-12 HR CONTINUOUS,19595717,CDM,986,RC,95717,HCPCS,outpatient,,,213.75,106.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
NR EEG W VIDEO PRO (VEEG)2-12 HR CONTINU,19595718,CDM,986,RC,95718,HCPCS,outpatient,,,281,140.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Test to measure electrical activity of muscles or nerves in 1 limb,19595860,CDM,983,RC,95860,HCPCS,outpatient,,,117.25,58.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Test to measure electrical activity of muscles or nerves in 2 limb,19595861,CDM,983,RC,95861,HCPCS,outpatient,,,185.75,92.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
EMG 3 EXTREMITY PRO,19595863,CDM,983,RC,95863,HCPCS,outpatient,,,223,111.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
EMG 4 EXTREMITY PRO,19595864,CDM,983,RC,95864,HCPCS,outpatient,,,238,119,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
NEEDLE EMG EXT W PARAPSIL AREAS,19595885,CDM,983,RC,95885,HCPCS,outpatient,,,44.75,22.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Test to assess for nerve damage,19595886,CDM,983,RC,95886,HCPCS,outpatient,,,108,54,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
NERVE CONDUCTION 1-2 STUDIES PRO,19595907,CDM,983,RC,95907,HCPCS,outpatient,,,129.5,64.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
NERVE CONDUCTION 3-4 STUDIES PRO,19595908,CDM,983,RC,95908,HCPCS,outpatient,,,162.5,81.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
NERVE CONDUCTION 5-6 STUDIES PRO,19595909,CDM,983,RC,95909,HCPCS,outpatient,,,193.75,96.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
NERVE CONDUCTION 7-8 STUDIES PRO,19595910,CDM,983,RC,95910,HCPCS,outpatient,,,258.5,129.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
NERVE CONDUCTION 9-10 STUDIES PRO,19595911,CDM,983,RC,95911,HCPCS,outpatient,,,323,161.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
NERVE CONDUCTION 11-12 STUDIES PRO,19595912,CDM,983,RC,95912,HCPCS,outpatient,,,387.75,193.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
NERVE CONDUCTION 13 OR MORE STUDIES PRO,19595913,CDM,983,RC,95913,HCPCS,outpatient,,,459.5,229.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CALITH REPOSITIONING MANEUVER,19595992,CDM,983,RC,95992,HCPCS,outpatient,,,137.5,68.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
LHI STANDARD COGNITIVE PERFORM TEST HR,19596125,CDM,983,RC,96125,HCPCS,outpatient,,,131.5,65.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
LHI MEDICAL OPINION,19599080,CDM,983,RC,99080,HCPCS,outpatient,,,68.25,34.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
LHI C FILE REVIEW,19599090,CDM,983,RC,99429,HCPCS,outpatient,,,68.25,34.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 60 min",19599205,CDM,983,RC,99205,HCPCS,outpatient,,,349.5,174.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OBSERVATION DISCHARGE,19599217,CDM,983,RC,99217,HCPCS,outpatient,,,174.75,87.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OBSERVATION CARE INITIAL LOW,19599218,CDM,983,RC,99218,HCPCS,outpatient,,,166.5,83.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OBSERVATION CARE INITIAL MODERATE,19599219,CDM,983,RC,99219,HCPCS,outpatient,,,275.5,137.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OBSERVATION CARE INITIAL HIGH,19599220,CDM,983,RC,99220,HCPCS,outpatient,,,385,192.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SUBSEQUENT OBSERVATION CARE PROB FOC,19599224,CDM,983,RC,99224,HCPCS,outpatient,,,78.75,39.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SUBSEQUESNT OBSERVATION CARE EXP PROB FO,19599225,CDM,983,RC,99225,HCPCS,outpatient,,,137.25,68.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SUBSEQUENT OBSERVATION CARE DETAILED,19599226,CDM,983,RC,99226,HCPCS,outpatient,,,205.25,102.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ER SCREEN MINIMAL,19599281,CDM,981,RC,99281,HCPCS,outpatient,,,54.5,27.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ER PAT /LOW,19599282,CDM,981,RC,99282,HCPCS,outpatient,,,106,53,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, moderately severe problem",19599283,CDM,981,RC,99283,HCPCS,outpatient,,,166,83,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem of high severity",19599284,CDM,981,RC,99284,HCPCS,outpatient,,,307.75,153.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem with significant threat to life or function",19599285,CDM,981,RC,99285,HCPCS,outpatient,,,458.25,229.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INIT NURSING FACILITY CARE PER DAY LOW,19599304,CDM,983,RC,99304,HCPCS,outpatient,,,208,104,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
NURSING FACILITY CARE SUBSEQUENT,19599307,CDM,983,RC,99307,HCPCS,outpatient,,,104.5,52.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
NURSING FACILITY CARE SUBSEQUENT,19599308,CDM,983,RC,99308,HCPCS,outpatient,,,158.25,79.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SUBS NURSING FACILITY CARE PER DAY MODER,19599309,CDM,983,RC,99309,HCPCS,outpatient,,,208.25,104.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
NURSING FACILITY CARE DISCHARGE DAY,19599315,CDM,983,RC,99315,HCPCS,outpatient,,,152.75,76.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
EP HOME VISIT LEVEL 4,19599349,CDM,983,RC,99349,HCPCS,outpatient,,,294.75,147.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
LHI VA DISABILITY EXAM PROLONGED,19599354,CDM,983,RC,99354,HCPCS,outpatient,,,205,102.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INDEPENDENT MEDICAL EXAM,19599371,CDM,983,RC,,,outpatient,,,525.75,262.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SMOKING CESSATION COUNSELING 3 TO 10 MIN,19599406,CDM,983,RC,99406,HCPCS,outpatient,,,27.25,13.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SMOKING CESSATION COUNSELING OVER 10 MIN,19599407,CDM,983,RC,99407,HCPCS,outpatient,,,54.5,27.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
BASIC LIFE AND DISABILITY EXAM,19599450,CDM,983,RC,99450,HCPCS,outpatient,,,371.75,185.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
LHI APPOINTMENT CANCELLATION OR NO SHOW,19599910,CDM,983,RC,99456,HCPCS,outpatient,,,55,27.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 60 min",19599998,CDM,983,RC,99205,HCPCS,outpatient,,,349.5,174.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
PHYSICIAN  HOURLY w DICTATION,19599999,CDM,983,RC,,,outpatient,,,557,278.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 10 minutes",19899202,CDM,983,RC,99202,HCPCS,outpatient,,,106.75,53.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 30 min",19899203,CDM,983,RC,99203,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 45 min",19899204,CDM,983,RC,99204,HCPCS,outpatient,,,266.75,133.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 60 min",19899205,CDM,983,RC,99205,HCPCS,outpatient,,,341.25,170.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient not requiring a physician,19899211,CDM,983,RC,99211,HCPCS,outpatient,,,26.75,13.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient requiring a physician,19899212,CDM,983,RC,99212,HCPCS,outpatient,,,58.75,29.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",19899213,CDM,983,RC,99213,HCPCS,outpatient,,,106.75,53.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 25 minutes",19899214,CDM,983,RC,99214,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient, visit typically 40 minutes",19899215,CDM,983,RC,99215,HCPCS,outpatient,,,229.25,114.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS GLOBAL-OTHER THAN PMH,20000024,CDM,969,RC,99024,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PHYSICIAN RECERTIFICATION HH PLAN,20000179,CDM,983,RC,G0179,HCPCS,outpatient,,,154.5,77.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PHYSICIAN CERTIFICATION HH PLAN OF CA,20000180,CDM,983,RC,G0180,HCPCS,outpatient,,,117.25,58.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS COUNSELING LUNG CANCER SCREEN LDCT,20000296,CDM,983,RC,G0296,HCPCS,outpatient,,,48,24,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ADJUST GASTRIC BAND DIAMETER VIA SUBC,20002083,CDM,983,RC,S2083,HCPCS,outpatient,,,138.75,69.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS NEEDLE CORE BREAST BX WO IMAG RIGHT,20002100,CDM,983,RC,19100,HCPCS,outpatient,,,389.25,194.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS TUBE THORACOSTOMY RT,20002551,CDM,983,RC,32551,HCPCS,outpatient,,,592,296,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DUPLEX SCAN/US LOW EXTRM LT OR LIMITE,20003926,CDM,972,RC,93926,HCPCS,outpatient,,,77.25,38.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
One sided or limited bilateral study,20003971,CDM,983,RC,93971,HCPCS,outpatient,,,58.75,29.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS US PUNCT ASPIR CYST BREAST LT,20008031,CDM,972,RC,19000,HCPCS,outpatient,,,149.5,74.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ER SCREEN MINIMAL,20009281,CDM,981,RC,99281,HCPCS,outpatient,,,53.5,26.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ER PAT /LOW,20009282,CDM,981,RC,99282,HCPCS,outpatient,,,106.75,53.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, moderately severe problem",20009283,CDM,981,RC,99283,HCPCS,outpatient,,,165.5,82.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem of high severity",20009284,CDM,981,RC,99284,HCPCS,outpatient,,,309.25,154.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem with significant threat to life or function",20009285,CDM,981,RC,99285,HCPCS,outpatient,,,458.75,229.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INIT NURSING FACILITY CARE PER DAY MO,20009305,CDM,983,RC,99305,HCPCS,outpatient,,,287.75,143.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Fine Needle Aspiration Biopsy without imaging,20010021,CDM,983,RC,10021,HCPCS,outpatient,,,192,96,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Incision and draige of abscess; simple or single and complex or multiple,20010060,CDM,983,RC,10060,HCPCS,outpatient,,,240,120,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INC DRAIN ABSCESS MULTIPLE,20010061,CDM,983,RC,10061,HCPCS,outpatient,,,432,216,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INC DRAIN PILONIDAL CYST SIMPLE,20010080,CDM,983,RC,10080,HCPCS,outpatient,,,176,88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INC DRAIN PILONIDAL CYST COMPLICATED,20010081,CDM,983,RC,10081,HCPCS,outpatient,,,623.75,311.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INC REMOVE FOR BODY SIMPLE,20010120,CDM,983,RC,10120,HCPCS,outpatient,,,234.5,117.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INC REMOVE FOR BODY COMPLICATED,20010121,CDM,983,RC,10121,HCPCS,outpatient,,,485.25,242.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Incision and draige of hematoma, seroma or fluid collection",20010140,CDM,983,RC,10140,HCPCS,outpatient,,,309.25,154.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Puncture aspiration of abscess, hematoma, bulla, or cyst",20010160,CDM,983,RC,10160,HCPCS,outpatient,,,245.5,122.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INC DRAIN COMPLEX POSTOP WOUND INF,20010180,CDM,983,RC,10180,HCPCS,outpatient,,,458.75,229.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of infected skin,20011000,CDM,983,RC,11000,HCPCS,outpatient,,,96,48,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DEBRID REM FOR MAT WFX DIS SUBCUT,20011010,CDM,983,RC,11010,HCPCS,outpatient,,,762.5,381.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DEBRID REM FOR MAT WFX DIS MUSCLE,20011011,CDM,983,RC,11011,HCPCS,outpatient,,,826.25,413.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DEBRIDEMENT OPEN FX SUBQ MUSCLE & BON,20011012,CDM,983,RC,11012,HCPCS,outpatient,,,1199.5,599.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DEBRIDEMENT SKIN SUBCUT TISSUE,20011042,CDM,983,RC,11042,HCPCS,outpatient,,,133.5,66.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"GS DEBRIDEMENT SKIN, SUBCU MUSCLE",20011043,CDM,983,RC,11043,HCPCS,outpatient,,,602.5,301.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DEBRIDE SUBQ BONE,20011044,CDM,983,RC,11044,HCPCS,outpatient,,,821,410.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DEBRIDMT SUBQ E/ADDTL 20 SQCM,20011045,CDM,983,RC,11045,HCPCS,outpatient,,,42.75,21.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DEBRIDMT MUSCLES E/ADDTL 20 SQCM,20011046,CDM,983,RC,11046,HCPCS,outpatient,,,90.75,45.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DEBRIDMT BONE E/ADDTL 20 SQCM,20011047,CDM,983,RC,11047,HCPCS,outpatient,,,154.5,77.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PARING CUTTING BEN HYPERKERATOTIC LES,20011055,CDM,983,RC,11055,HCPCS,outpatient,,,69.5,34.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Paring or cutting of benign hyperkeratotic lesion,20011056,CDM,983,RC,11056,HCPCS,outpatient,,,96,48,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PARING CUT BEN HYPERKER LES > 4,20011057,CDM,983,RC,11057,HCPCS,outpatient,,,122.75,61.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Tangential biopsy of skin (e.g., for example, shave, scoop, saucerize, curette); single lesion",20011102,CDM,983,RC,11102,HCPCS,outpatient,,,96,48,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Tangential biopsy of skin (e.g., for example, shave, scoop, saucerize, curette); each separate/additiol lesion",20011103,CDM,983,RC,11103,HCPCS,outpatient,,,53.5,26.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INCISIOL BX SKIN SINGLE LESION,20011106,CDM,983,RC,11106,HCPCS,outpatient,,,144,72,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Removal of skin tags, multiple fibrocutaneous tags, any area",20011200,CDM,983,RC,11200,HCPCS,outpatient,,,170.75,85.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REMOVAL SKIN TAGS EA ADDTL 10 OR PART,20011201,CDM,983,RC,11201,HCPCS,outpatient,,,48,24,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SHAVE EPID DERMAL LES SINGLE <.5 CM,20011300,CDM,983,RC,11300,HCPCS,outpatient,,,80,40,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SHAVE EPID DERMAL LES SINGLE .6 TO 1,20011301,CDM,983,RC,11301,HCPCS,outpatient,,,133.5,66.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SHAVE EPID DERMAL LES SINGLE 1.1-2.0,20011302,CDM,983,RC,11302,HCPCS,outpatient,,,165.5,82.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SHAVE EPID DERMAL LES SINGLE >2.0,20011303,CDM,983,RC,11303,HCPCS,outpatient,,,197.25,98.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SHAVE EPID DERMAL LES SINGLE <.5 CM,20011305,CDM,983,RC,11305,HCPCS,outpatient,,,106.75,53.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SHAVING EPIDERMAL/DERMAL LESION .6-1.,20011306,CDM,983,RC,11306,HCPCS,outpatient,,,154.5,77.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SHAVING EPIDERMAL/DERM LES 1.1-2.0CM,20011307,CDM,983,RC,11307,HCPCS,outpatient,,,181.25,90.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SHAVING EPIDERMA/DERM LESION 0.5CM<,20011310,CDM,983,RC,11310,HCPCS,outpatient,,,122.75,61.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SHAVE DERMAL LESIN .6 TO 1.0 CM FACE,20011311,CDM,983,RC,11311,HCPCS,outpatient,,,165.5,82.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION BEN .5 CM OR LESS,20011400,CDM,983,RC,11400,HCPCS,outpatient,,,186.75,93.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Under Excision-Benign Lesions Procedures on the Skin 0.6-1 CM,20011401,CDM,983,RC,11401,HCPCS,outpatient,,,250.5,125.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION BEN 1.1 TO 2.0 CM,20011402,CDM,983,RC,11402,HCPCS,outpatient,,,277.25,138.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION BEN 2.1 TO 3.0 CM,20011403,CDM,983,RC,11403,HCPCS,outpatient,,,357.25,178.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION BEN 3.1 TO 4.0 CM,20011404,CDM,983,RC,11404,HCPCS,outpatient,,,394.5,197.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION BEN > 4.0 CM,20011406,CDM,983,RC,11406,HCPCS,outpatient,,,597,298.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION BEN <.5 CM,20011420,CDM,983,RC,11420,HCPCS,outpatient,,,202.75,101.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION BEN .6 TO 1.0 CM,20011421,CDM,983,RC,11421,HCPCS,outpatient,,,277.25,138.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Under Excision-Benign Lesions Procedures on the Skin 1.1-2 CM,20011422,CDM,983,RC,11422,HCPCS,outpatient,,,336,168,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION BEN 2.1 TO 3.0 CM,20011423,CDM,983,RC,11423,HCPCS,outpatient,,,389.25,194.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION BEN 3.1 TO 4.0 CM,20011424,CDM,983,RC,11424,HCPCS,outpatient,,,453.25,226.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXC BENIGN LESION >4.0 CM SCALP NECK,20011426,CDM,983,RC,11426,HCPCS,outpatient,,,762.5,381.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION BEN LESION <.5 CM,20011440,CDM,983,RC,11440,HCPCS,outpatient,,,240,120,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION BEN LESION .6 TO 1.0 CM,20011441,CDM,983,RC,11441,HCPCS,outpatient,,,320,160,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION BEN LESION 1.1 TO 2.0 CM,20011442,CDM,983,RC,11442,HCPCS,outpatient,,,357.25,178.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION BEN LESION 2.1 TO 3.0 CM,20011443,CDM,983,RC,11443,HCPCS,outpatient,,,442.5,221.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION BEN LESION 3.1 TO 4.0 CM,20011444,CDM,983,RC,11444,HCPCS,outpatient,,,570.5,285.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION BEN LESION > 4.0 CM FACE EAR,20011446,CDM,983,RC,11446,HCPCS,outpatient,,,858.5,429.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION SKIN SUBQ HIDRADENTITS SIMPL,20011450,CDM,983,RC,11450,HCPCS,outpatient,,,592,296,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISE MALIG LESION <.5CM,20011600,CDM,983,RC,11600,HCPCS,outpatient,,,282.75,141.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION MALIG .6 TO 1.0 CM,20011601,CDM,983,RC,11601,HCPCS,outpatient,,,367.75,183.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Excision-Malignt Lesions,20011602,CDM,983,RC,11602,HCPCS,outpatient,,,400,200,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXC MALIGNT 2.1 TO 3.0,20011603,CDM,983,RC,11603,HCPCS,outpatient,,,479.75,239.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXC MALIG LES TRUNK ARM LEGS 3.1 TO 4,20011604,CDM,983,RC,11604,HCPCS,outpatient,,,527.75,263.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION MALIG > 4.0 CM,20011606,CDM,983,RC,11606,HCPCS,outpatient,,,794.25,397.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION MALIG.6 TO 1.0 CM,20011621,CDM,983,RC,11621,HCPCS,outpatient,,,367.75,183.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION MALIG 1.1 TO 2.0 CM,20011622,CDM,983,RC,11622,HCPCS,outpatient,,,426.5,213.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"GS EXC MALIG LES SCALP, NECK, HANDS FEET",20011624,CDM,983,RC,11624,HCPCS,outpatient,,,602.5,301.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION MALIG 2.1 TO 3.0 CM,20011626,CDM,983,RC,11626,HCPCS,outpatient,,,767.5,383.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION MALIG<.5 CM,20011640,CDM,983,RC,11640,HCPCS,outpatient,,,304,152,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION MALIG .6 TO 1.0 CM,20011641,CDM,983,RC,11641,HCPCS,outpatient,,,394.5,197.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION MALIG 1.1 TO 2.0 CM,20011642,CDM,983,RC,11642,HCPCS,outpatient,,,469.25,234.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION MALIG 2.1 TO 3.0 CM,20011643,CDM,983,RC,11643,HCPCS,outpatient,,,586.5,293.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION MALIG >4.0 CM,20011646,CDM,983,RC,11646,HCPCS,outpatient,,,1045,522.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Separation and removal of the entire il plate or a portion of il plate,20011730,CDM,983,RC,11730,HCPCS,outpatient,,,170.75,85.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION IL & MATRIX PART OR COMP,20011750,CDM,983,RC,11750,HCPCS,outpatient,,,453.25,226.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS BIOPSY IL UNIT,20011755,CDM,983,RC,11755,HCPCS,outpatient,,,229.25,114.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REPAIR OF IL BED,20011760,CDM,983,RC,11760,HCPCS,outpatient,,,336,168,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RECONSTRUCTION IL BED W GRAFT,20011762,CDM,983,RC,11762,HCPCS,outpatient,,,527.75,263.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION PILONIDAL CYST SINUS EXT,20011771,CDM,983,RC,11771,HCPCS,outpatient,,,1066.25,533.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION PILONIDAL CYST SINUS COMP,20011772,CDM,983,RC,11772,HCPCS,outpatient,,,1375.5,687.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INSERT TISSUE EXPANDER,20011960,CDM,983,RC,11960,HCPCS,outpatient,,,2297.5,1148.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REMOVAL IMPLANTABLE CONTRACEPT,20011976,CDM,983,RC,11976,HCPCS,outpatient,,,197.25,98.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Simple repair of superficial wounds of scalp, neck, axillae, exterl genitalia, trunk and/or extremities",20012001,CDM,983,RC,12001,HCPCS,outpatient,,,197.25,98.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SIMP RPR SUPERFICIAL WD 2.6 TO 7.5 CM,20012002,CDM,983,RC,12002,HCPCS,outpatient,,,218.75,109.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SIMP RPR SUPERFICIAL WD 7.6 TO 12.5 C,20012004,CDM,983,RC,12004,HCPCS,outpatient,,,256,128,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SIMP RPR SUPERFICIAL WD 12.5 TO 20.0M,20012005,CDM,983,RC,12005,HCPCS,outpatient,,,320,160,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SIMP RPR SUPERFICIAL WD 20.1 TO 30.0,20012006,CDM,983,RC,12006,HCPCS,outpatient,,,405.25,202.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes",20012011,CDM,983,RC,12011,HCPCS,outpatient,,,202.75,101.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SIMP RPR SUPERFICIAL WD 2.6 TO 5.0 CM,20012013,CDM,983,RC,12013,HCPCS,outpatient,,,229.25,114.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SIMP RPR SUPERFICIAL WD 5.1 TO 7.5 CM,20012014,CDM,983,RC,12014,HCPCS,outpatient,,,277.25,138.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS TRT SUPERFICIAL WD DISHISCENCE SIMP,20012020,CDM,983,RC,12020,HCPCS,outpatient,,,485.25,242.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAYER CLOSE WOUNDS < 2.5 CM,20012031,CDM,983,RC,12031,HCPCS,outpatient,,,400,200,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAYER CLOSE WOUNDS 2.6 TO 7.5 CM,20012032,CDM,983,RC,12032,HCPCS,outpatient,,,485.25,242.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAYER CLOSE WOUNDS 7.6 TO 12.5 CM,20012034,CDM,983,RC,12034,HCPCS,outpatient,,,517,258.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAYER CLOSE WOUNDS 12.6 TO 20.0 CM,20012035,CDM,983,RC,12035,HCPCS,outpatient,,,618.5,309.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAYER CLOSE WOUNDS 20.1 TO 30.0,20012036,CDM,983,RC,12036,HCPCS,outpatient,,,719.75,359.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REPAIR INTERM >30 CM SCALP AXILLA TRU,20012037,CDM,983,RC,12037,HCPCS,outpatient,,,826.25,413.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"GS RPR INTERM NECK,HAND,FEET EXT GENITAL",20012041,CDM,983,RC,12041,HCPCS,outpatient,,,320,160,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAYER CLOSE WOUNDS 2.6 TO 7.5 CM,20012042,CDM,983,RC,12042,HCPCS,outpatient,,,357.25,178.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAYER CLOSE WOUNDS 12.6 TO 20.0 CM,20012045,CDM,983,RC,12046,HCPCS,outpatient,,,757,378.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAYER CLOSE WOUNDS >2.5 CM,20012051,CDM,983,RC,12051,HCPCS,outpatient,,,458.75,229.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAYER CLOSE WOUNDS 2.6 TO 5.0 CM,20012052,CDM,983,RC,12052,HCPCS,outpatient,,,533.25,266.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAYER CLOSE WOUNDS 5.1 TO 7.5 CM,20012053,CDM,983,RC,12053,HCPCS,outpatient,,,549.25,274.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REPAIR COMPLEX TRUNK 2.6 TO 7.5 CM,20013101,CDM,983,RC,13101,HCPCS,outpatient,,,719.75,359.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REPAIR COMPLEX TRUNK EA ADD 5 CM LESS,20013102,CDM,983,RC,13102,HCPCS,outpatient,,,202.75,101.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REPAIR COMPLEX SCALP 1.1 TO 2.5 CM,20013120,CDM,983,RC,13120,HCPCS,outpatient,,,623.75,311.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REPAIR COMPLEX SCALP 2.6 TO 7.5 CM,20013121,CDM,983,RC,13121,HCPCS,outpatient,,,810.25,405.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REPAIR COMPLEX SCALP EA ADD 5CM LESS,20013122,CDM,983,RC,13122,HCPCS,outpatient,,,234.5,117.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REPAIR COMPLEX FOREHEAD 2.6 TO 7.5 CM,20013132,CDM,983,RC,13132,HCPCS,outpatient,,,1167.25,583.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REPAIR COMPLEX FOREHEAD EA ADD 5CM LE,20013133,CDM,983,RC,13133,HCPCS,outpatient,,,357.25,178.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REPAIR COMPLEX EYELIDS 2.6 TO 7.5 CM,20013152,CDM,983,RC,13152,HCPCS,outpatient,,,1092.75,546.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SECONDARY CLOSURE SURGICAL,20013160,CDM,983,RC,13160,HCPCS,outpatient,,,2366.75,1183.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ADJACENT TISSUE TRANSFER TRUNK 10SQ C,20014000,CDM,983,RC,14000,HCPCS,outpatient,,,1252.75,626.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ADJ TISSUE TRANSFER <10 SQ CM,20014020,CDM,983,RC,14020,HCPCS,outpatient,,,1428.75,714.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PINCH GRAFT UP TO 2 CM,20015050,CDM,983,RC,15050,HCPCS,outpatient,,,1098.25,549.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SPLIT THICKNESS AUTOGRAFT <100SQ CM,20015100,CDM,983,RC,15100,HCPCS,outpatient,,,1844.5,922.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS FULL THICKNESS GRAFT < 20 SQ CM,20015220,CDM,983,RC,15220,HCPCS,outpatient,,,1567,783.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS FULL THICKNESS GRAFT FREE < 20 SQ CM,20015240,CDM,983,RC,15240,HCPCS,outpatient,,,1988.25,994.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION SKIN/SUBQ ABDOMEN,20015830,CDM,983,RC,15830,HCPCS,outpatient,,,2532,1266,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION COCCYGEAL PRESSURE ULCER,20015931,CDM,983,RC,15931,HCPCS,outpatient,,,1945.75,972.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION SACRAL PRESSURE ULCER,20015934,CDM,983,RC,15934,HCPCS,outpatient,,,2670.75,1335.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INIT TRT FIRST DEG BURN LOCAL,20016000,CDM,983,RC,16000,HCPCS,outpatient,,,96,48,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DRESS AND OR  DEBRIDE < 5%,20016020,CDM,983,RC,16020,HCPCS,outpatient,,,106.75,53.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DRESS AND OR  DEBRIDE MED 5 TO 10%,20016025,CDM,983,RC,16025,HCPCS,outpatient,,,309.25,154.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ESCHAROTOMY INITIAL INCISION,20016035,CDM,983,RC,16035,HCPCS,outpatient,,,655.75,327.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of pre-cancerous lesion,20017000,CDM,983,RC,17000,HCPCS,outpatient,,,133.5,66.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of 2-14 pre-cancerous lesions,20017003,CDM,983,RC,17003,HCPCS,outpatient,,,16.25,8.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DESTRUCTION 15 OR MORE LESIONS,20017004,CDM,983,RC,17004,HCPCS,outpatient,,,341.25,170.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of 1-14 common or plantar warts,20017110,CDM,983,RC,17110,HCPCS,outpatient,,,165.5,82.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of >15 common or plantar warts,20017111,CDM,983,RC,17111,HCPCS,outpatient,,,208,104,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DESTRUCTION MALIGNT LESION <.5 CM,20017260,CDM,983,RC,17260,HCPCS,outpatient,,,170.75,85.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DESTRUCTION MALIG LESION .6 TO 1.0 CM,20017261,CDM,983,RC,17261,HCPCS,outpatient,,,229.25,114.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DESTRUCTION MALIG LESION .< .5 CM,20017280,CDM,983,RC,17280,HCPCS,outpatient,,,224,112,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DESTRUCTION MALIG LESION .6 TO 1.0 CM,20017281,CDM,983,RC,17281,HCPCS,outpatient,,,314.5,157.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CYROTHERAPY FOR ACNE,20017340,CDM,983,RC,17340,HCPCS,outpatient,,,128,64,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXPLORATION  ABSCESS AXILLA,20017999,CDM,983,RC,17999,HCPCS,outpatient,,,682.5,341.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS US CYST ASP BREAST RT,20019000,CDM,983,RC,19000,HCPCS,outpatient,,,266.75,133.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PUNCTURE ASPIR CYST BREAST EA ADD,20019001,CDM,983,RC,19001,HCPCS,outpatient,,,69.5,34.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS MASTOTOMY W EXPLORATION,20019020,CDM,983,RC,19020,HCPCS,outpatient,,,725.25,362.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS BIOPSY BREAST PLACEMENT LOCALIZATION,20019083,CDM,983,RC,19083,HCPCS,outpatient,,,485.25,242.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS NEEDLE CORE BREAST BX WO IMAG BIL,20019100,CDM,983,RC,19100,HCPCS,outpatient,,,773,386.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS BIOPSY OF BREAST OPEN INCISIOL,20019101,CDM,983,RC,19101,HCPCS,outpatient,,,559.75,279.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
REMOVAL OF BREAST LESION,20019120,CDM,983,RC,19120,HCPCS,outpatient,,,1023.5,511.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION BREAST LESION PREOP MARKER,20019125,CDM,983,RC,19125,HCPCS,outpatient,,,1135.5,567.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PLACEMENT RADIOTHERAPY EXPANDABLE CAT,20019296,CDM,983,RC,19296,HCPCS,outpatient,,,559.75,279.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS MASTECTOMY PARTIAL,20019301,CDM,983,RC,19301,HCPCS,outpatient,,,1753.75,876.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS MASTECTOMY MODIFIED RADICAL W/ LYMPH,20019307,CDM,983,RC,19307,HCPCS,outpatient,,,2969,1484.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS NIPPLE AREOLA RECONSTRUCTION,20019350,CDM,983,RC,19350,HCPCS,outpatient,,,1759,879.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXPLORATION PENETRATING WOUND NECK,20020100,CDM,983,RC,20100,HCPCS,outpatient,,,1791.25,895.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXPLORATION PENETRATING WOUND EXTREM,20020103,CDM,983,RC,20103,HCPCS,outpatient,,,938.25,469.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS BIOPSY MUSCLE SUPERFICIAL,20020205,CDM,983,RC,20205,HCPCS,outpatient,,,405.25,202.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS BIOPSY MUSCLE PERCUTANEOUS NEEDLE,20020206,CDM,983,RC,20206,HCPCS,outpatient,,,170.75,85.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REMOVAL FOR BODY IN MUSCLE TENDON SIM,20020520,CDM,983,RC,20520,HCPCS,outpatient,,,367.75,183.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CARPAL TUNNEL INJECTION,20020526,CDM,983,RC,20526,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Injection of medication into a tendon or ligament,20020550,CDM,983,RC,20550,HCPCS,outpatient,,,85.5,42.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS TRIGGER PT INJ MUS,20020552,CDM,983,RC,20552,HCPCS,outpatient,,,101.25,50.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a small joint/bursa without ultrasound,20020600,CDM,983,RC,20600,HCPCS,outpatient,,,85.5,42.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a large joint/bursa without ultrasound,20020605,CDM,983,RC,20605,HCPCS,outpatient,,,90.75,45.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a major joint/bursa without ultrasound,20020610,CDM,983,RC,20610,HCPCS,outpatient,,,112.25,56.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ARTHROCENTESIS ASP/INJ INTERM JT/BURS,20020611,CDM,983,RC,20611,HCPCS,outpatient,,,122.75,61.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ASPIRATION AND INJ TRT BONE CYST,20020615,CDM,983,RC,20615,HCPCS,outpatient,,,298.75,149.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REMOVAL OF IMPLANT; SUPERFICIAL,20020670,CDM,983,RC,20670,HCPCS,outpatient,,,389.25,194.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REMOVAL OF IMPLANT DEEP,20020680,CDM,983,RC,20680,HCPCS,outpatient,,,1066.25,533.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REPLANTATION DIGIT EXCL THUMB,20020816,CDM,983,RC,20816,HCPCS,outpatient,,,10101,5050.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS BONE GRAFT MINOR OR SMALL,20020900,CDM,983,RC,20900,HCPCS,outpatient,,,725.25,362.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"GS EXCIS, TUMOR, SOFT TIS OR SCALP SUBC",20021012,CDM,983,RC,21012,HCPCS,outpatient,,,938.25,469.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT MANDIBULAR MAX ALVEOLAR,20021400,CDM,983,RC,21400,HCPCS,outpatient,,,256,128,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT MANDIBULAR FRACTURE WO MANIP,20021450,CDM,983,RC,21450,HCPCS,outpatient,,,1087.5,543.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS BX SOFT TISSUE NECK OR THORAX,20021550,CDM,960,RC,21550,HCPCS,outpatient,,,405.25,202.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION SOFT TISSUE NECK SUBQ >3 CM,20021552,CDM,983,RC,21552,HCPCS,outpatient,,,1210,605,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXC TUMOR SOFT TISSUE 5CM >,20021554,CDM,983,RC,21554,HCPCS,outpatient,,,2009.5,1004.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION TUMOR SOFT TISSUE NECK OR TH,20021555,CDM,983,RC,21555,HCPCS,outpatient,,,853,426.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION TUMOR SOFT TISS NECK/ANT THO,20021556,CDM,983,RC,21556,HCPCS,outpatient,,,1087.5,543.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS BIOPSY SOFT TISSUE BACK FLANK SUPERFI,20021920,CDM,983,RC,21920,HCPCS,outpatient,,,400,200,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION TUMOR SOFT TISSUE OF BACK FL,20021930,CDM,983,RC,21930,HCPCS,outpatient,,,965,482.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION TUM SOFT TISS BACK SUBQ 3CM>,20021931,CDM,983,RC,21931,HCPCS,outpatient,,,1274,637,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISE TUMOR SOFT TISSUE BAK OR FLNK,20021932,CDM,983,RC,21932,HCPCS,outpatient,,,1108.75,554.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXC TUMOR SOFT TISSUE BACK SUBFASCIAL,20021933,CDM,983,RC,21933,HCPCS,outpatient,,,2302.75,1151.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT VERTEBRAL BODY FX,20022310,CDM,983,RC,22310,HCPCS,outpatient,,,687.5,343.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION SOFT TISS TUMOR ABD WALL >5C,20022901,CDM,983,RC,22901,HCPCS,outpatient,,,1807,903.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION TUMOR SOFT TIS ABD WAL <3 CM,20022902,CDM,983,RC,22902,HCPCS,outpatient,,,890.25,445.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION TUMOR SOFT TIS ABD WALL 3 CM,20022903,CDM,983,RC,22903,HCPCS,outpatient,,,1220.75,610.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INSERTION MESH ABDOMIL WALL,20022999,CDM,983,RC,22999,HCPCS,outpatient,,,751.75,375.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION SOFT TISSUE TUMOR SUBC SHOUL,20023075,CDM,983,RC,23075,HCPCS,outpatient,,,463.75,231.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLAVICULECTOMY PARTIAL,20023120,CDM,983,RC,23120,HCPCS,outpatient,,,2382.75,1191.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ACROMIOPLASTY OR ACROMIONECTOMY PA,20023130,CDM,983,RC,23130,HCPCS,outpatient,,,2750.75,1375.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION OR CURETTAGE BONE CYST BN TU,20023140,CDM,983,RC,23140,HCPCS,outpatient,,,2121.5,1060.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PARTIAL EXCISION BONE PROX HUMERUS,20023184,CDM,983,RC,23184,HCPCS,outpatient,,,2889,1444.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REPAIR RUPTURED MUSCULOTENDIOUS CUFF,20023410,CDM,983,RC,23410,HCPCS,outpatient,,,4088.25,2044.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REPAIR RUPTURED MUSCULOTENDIOUS CUFF,20023420,CDM,983,RC,23420,HCPCS,outpatient,,,5154.5,2577.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CAPSULORRHAPHY ANTERIOR,20023450,CDM,983,RC,23450,HCPCS,outpatient,,,5058.5,2529.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CAPSULORRHAPHY ANTERIOR W LABRAL,20023455,CDM,983,RC,23455,HCPCS,outpatient,,,5671.5,2835.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT CLAVICULAR FX WO MANIP,20023500,CDM,983,RC,23500,HCPCS,outpatient,,,506.5,253.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT CLAVICULAR FX W MANIP,20023505,CDM,983,RC,23505,HCPCS,outpatient,,,815.75,407.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OPEN TRT STERNOCLAVICULAR DISLOCATION,20023530,CDM,983,RC,23530,HCPCS,outpatient,,,1583.25,791.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT ACROMIOCLAVICULAR DISL WO M,20023540,CDM,983,RC,23540,HCPCS,outpatient,,,517,258.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT SCAPULAR FX WO M,20023570,CDM,983,RC,23570,HCPCS,outpatient,,,549.25,274.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT PROXIMAL HUMERAL FX,20023600,CDM,983,RC,23600,HCPCS,outpatient,,,709,354.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OPEN TRT PROXIMAL HUMERAL,20023615,CDM,983,RC,23615,HCPCS,outpatient,,,2537.5,1268.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT GREAT HUMERAL TUBEROSITY FX,20023620,CDM,983,RC,23620,HCPCS,outpatient,,,597,298.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT SHOULDER DISLOCATION,20023650,CDM,983,RC,23650,HCPCS,outpatient,,,655.75,327.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT SHOULDER DISLOCATION ANES,20023665,CDM,983,RC,23665,HCPCS,outpatient,,,975.5,487.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS MANIP ANES SHOULDER JT,20023700,CDM,983,RC,23700,HCPCS,outpatient,,,575.75,287.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INC DRAIN ELBOW BURSA,20023931,CDM,983,RC,23931,HCPCS,outpatient,,,400,200,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION TUMOR SOFT TISS UP ARM/ELBOW,20024073,CDM,983,RC,24073,HCPCS,outpatient,,,2116.25,1058.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXC TUMOR SOFT SUBCU UPPER ARM ELBOW,20024075,CDM,983,RC,24075,HCPCS,outpatient,,,799.75,399.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISE TUMOR SOFT UPPER ARM ELBOW DE,20024076,CDM,983,RC,24076,HCPCS,outpatient,,,1375.5,687.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION OLECRANON BURSA,20024105,CDM,983,RC,24105,HCPCS,outpatient,,,949,474.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT HUMERAL EPICONDYLAR FX,20024560,CDM,983,RC,24560,HCPCS,outpatient,,,666.5,333.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT HUMERAL CONDYLAR FX,20024576,CDM,983,RC,24576,HCPCS,outpatient,,,709,354.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PERCUTANEOUS SKELETAL FIX HUMERAL,20024582,CDM,983,RC,24582,HCPCS,outpatient,,,2244.25,1122.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS TRT CLSD ELBOW DISL W ANES,20024605,CDM,983,RC,24605,HCPCS,outpatient,,,1300.5,650.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OPEN TRT ACUTE CHRON ELBOW DISLOC,20024615,CDM,983,RC,24615,HCPCS,outpatient,,,2111,1055.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OPEN TRT MONTEGGOA FX DIS ELBOW,20024635,CDM,983,RC,24635,HCPCS,outpatient,,,2244.25,1122.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT RADIAL SUB IN CHILD,20024640,CDM,983,RC,24640,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT RADIAL HD NECK FX WO MANIP,20024650,CDM,983,RC,24650,HCPCS,outpatient,,,549.25,274.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT ULR FX PROX END WO MANIP,20024670,CDM,983,RC,24670,HCPCS,outpatient,,,618.5,309.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INC EXTENSOR TENDON SHEATH WRIST,20025000,CDM,983,RC,25000,HCPCS,outpatient,,,965,482.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INC DRAIN FORARM WRIST DEEP ABSCESS,20025028,CDM,983,RC,25028,HCPCS,outpatient,,,1428.75,714.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXC TUMOR SOFT TISS FOREARM/WRIS SQ<3,20025075,CDM,983,RC,25075,HCPCS,outpatient,,,959.5,479.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXC TUMOR SOFT TISSUE FORARM DEEP,20025076,CDM,983,RC,25076,HCPCS,outpatient,,,1258.25,629.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXC GANGLION WRIST PRIM,20025111,CDM,983,RC,25111,HCPCS,outpatient,,,885,442.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXC GANGLION WRIST PRIM RECURRENT,20025112,CDM,983,RC,25112,HCPCS,outpatient,,,1092.75,546.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RAD EXC BURSA SYNOVIA WRIST FOREARM,20025115,CDM,983,RC,25115,HCPCS,outpatient,,,2292.25,1146.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXPLORATION REM DEEP FOR BODY FOREARM,20025248,CDM,983,RC,25248,HCPCS,outpatient,,,1247.25,623.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RPR TENDON MUSC FOREARM/WRIST PRIM SI,20025260,CDM,983,RC,25260,HCPCS,outpatient,,,1935,967.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT RADIAL SHAFT FX WO MANIP,20025500,CDM,983,RC,25500,HCPCS,outpatient,,,570.5,285.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT RADIAL SHAFT FX W MANIP,20025505,CDM,983,RC,25505,HCPCS,outpatient,,,1146,573,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OPEN TRT RADIAL SHAFT FX,20025525,CDM,983,RC,25525,HCPCS,outpatient,,,2388,1194,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT ULR SHAFT FX WO MANIP,20025530,CDM,983,RC,25530,HCPCS,outpatient,,,538.5,269.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT RADIAL YKR SHAFT FX WO MAN,20025560,CDM,983,RC,25560,HCPCS,outpatient,,,565.25,282.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT RADIAL YKR SHAFT FX W MAN,20025565,CDM,983,RC,25565,HCPCS,outpatient,,,1194,597,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OPEN TRT RADIAL & UL,20025575,CDM,983,RC,25575,HCPCS,outpatient,,,2606.5,1303.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT DISTAL RADIAL FX,20025600,CDM,983,RC,25600,HCPCS,outpatient,,,773,386.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT OF CARPAL SCAPHOID FX WO MAN,20025622,CDM,983,RC,25622,HCPCS,outpatient,,,996.75,498.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT CARPAL BONE FX WO MANIP EA,20025630,CDM,983,RC,25630,HCPCS,outpatient,,,810.25,405.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT ULR STYLOID FX,20025650,CDM,983,RC,25650,HCPCS,outpatient,,,1119.5,559.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DRAIGE FINGER ABSC,20026010,CDM,981,RC,26010,HCPCS,outpatient,,,586.5,293.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DRAIN FINGER ABS COMP,20026011,CDM,983,RC,26011,HCPCS,outpatient,,,1045,522.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DRAIN TENDON SHEATH DIGIT/PALM EA,20026020,CDM,983,RC,26020,HCPCS,outpatient,,,1796.25,898.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS TENDON SHEATH INCISION,20026055,CDM,983,RC,26055,HCPCS,outpatient,,,1604.75,802.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ARTHROTOMY IP JOINT,20026080,CDM,983,RC,26080,HCPCS,outpatient,,,900.75,450.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION TUMOR OR VASCULAR MALFORM,20026111,CDM,983,RC,26111,HCPCS,outpatient,,,1204.75,602.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REMOVE HAND LESION SUB,20026115,CDM,983,RC,26115,HCPCS,outpatient,,,1471.25,735.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS FASCIECTOMY PARTIAL PALER RELEASE SIN,20026123,CDM,983,RC,26123,HCPCS,outpatient,,,1578,789,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS FASCIECTOMY PARTIAL PALMER EA ADD DIG,20026125,CDM,983,RC,26125,HCPCS,outpatient,,,570.5,285.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXC LESION TENDON SHEATH JT CAPSULE,20026160,CDM,983,RC,26160,HCPCS,outpatient,,,1529.75,764.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REMOVAL OF IMPLANT FROM FINGER/HAND,20026320,CDM,983,RC,26320,HCPCS,outpatient,,,1700.25,850.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RPR ADV FLEXOR TENDON,20026350,CDM,983,RC,26350,HCPCS,outpatient,,,3027.75,1513.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RPR EXTENSOR TENDON HAND,20026410,CDM,983,RC,26410,HCPCS,outpatient,,,2031,1015.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RPR EXTENSOR TENDON FINGER,20026418,CDM,983,RC,26418,HCPCS,outpatient,,,2121.5,1060.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT METACARPAL FX,20026600,CDM,983,RC,26600,HCPCS,outpatient,,,719.75,359.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT METACARPAL FX W MANIP,20026605,CDM,983,RC,26605,HCPCS,outpatient,,,687.5,343.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OPEN TRT METACARPAL FX  SINGLE,20026615,CDM,983,RC,26615,HCPCS,outpatient,,,2057.75,1028.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT PHALANGEAL SHAFT FX,20026720,CDM,983,RC,26720,HCPCS,outpatient,,,522.5,261.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT PHALANGEAL SHAFT FX W MANI,20026725,CDM,983,RC,26725,HCPCS,outpatient,,,927.5,463.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OPEN TRT PHAL SHAFT FX EA,20026735,CDM,983,RC,26735,HCPCS,outpatient,,,2004.5,1002.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT ARTICULAR FX EA,20026740,CDM,983,RC,26740,HCPCS,outpatient,,,687.5,343.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT ARTICULAR FX EA W MANIP,20026742,CDM,983,RC,26742,HCPCS,outpatient,,,1162.25,581.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OPEN TRT ARTICULAR FX EA,20026746,CDM,983,RC,26746,HCPCS,outpatient,,,2254.75,1127.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD  TRT ARTICULAR FX EA W MANIP,20026750,CDM,983,RC,26750,HCPCS,outpatient,,,490.5,245.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OPEN TRT DISTAL PHAL FX,20026765,CDM,983,RC,26765,HCPCS,outpatient,,,1444.75,722.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT INTERPHALANGEAL JT DISLOCATI,20026770,CDM,983,RC,26770,HCPCS,outpatient,,,709,354.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PERCUTANEOUS SKELETAL FIXATION,20026776,CDM,983,RC,26776,HCPCS,outpatient,,,1402,701,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OPEN TRT INTERPHALANGEAL JT DISLOC,20026785,CDM,983,RC,26785,HCPCS,outpatient,,,1492.5,746.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ARTHRODESIS INTERPHALAGEAL JT WWO I,20026860,CDM,983,RC,26860,HCPCS,outpatient,,,2158.75,1079.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS AMPUTATION FINGER OR THUMB,20026951,CDM,983,RC,26951,HCPCS,outpatient,,,1812.5,906.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PARTIAL EXCISION SUPERFICIAL DEEP,20027071,CDM,983,RC,27071,HCPCS,outpatient,,,4077.75,2038.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RADICAL RESECTION TUMOR INF INN BONE,20027078,CDM,983,RC,27078,HCPCS,outpatient,,,5698,2849,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REMOVAL FB PELVIS/HIP SQ TISSUE,20027086,CDM,983,RC,27086,HCPCS,outpatient,,,416,208,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INJ HIP ARTHROGRAPHY W ANES,20027095,CDM,983,RC,27095,HCPCS,outpatient,,,943.5,471.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ACETABULOPLASTY RESECTION FEMORAL,20027122,CDM,983,RC,27122,HCPCS,outpatient,,,5538.25,2769.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT COCCYGEAL FX,20027200,CDM,983,RC,27200,HCPCS,outpatient,,,629.25,314.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT FEMORAL FX WO MANIP,20027230,CDM,983,RC,27230,HCPCS,outpatient,,,1567,783.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PERCUTANEOUS SKELETAL FIXATION OF FEM,20027235,CDM,983,RC,27235,HCPCS,outpatient,,,4690.75,2345.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OPEN TRT FEMORAL FX,20027236,CDM,983,RC,27236,HCPCS,outpatient,,,5373,2686.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS TRT INTERTROCHANETERIC PERITROCHANTER,20027244,CDM,983,RC,27244,HCPCS,outpatient,,,5277,2638.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT GREATER TROCHANTERIC FX,20027246,CDM,983,RC,27246,HCPCS,outpatient,,,1332.75,666.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT HIP DISLOCATION TRAU WO ANES,20027250,CDM,983,RC,27250,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT HIP DISLOCATION TRAU W ANES,20027252,CDM,983,RC,27252,HCPCS,outpatient,,,2217.5,1108.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OPEN TRT HIP DISLOCATION W FIXATION,20027253,CDM,983,RC,27253,HCPCS,outpatient,,,4131,2065.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ARTHRODESIS SACROILIAC JT,20027280,CDM,983,RC,27280,HCPCS,outpatient,,,4408.25,2204.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DISARTICULATION OF HIP,20027295,CDM,983,RC,27295,HCPCS,outpatient,,,5293,2646.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INC DRAIN DEEP ABSCESS BURSA KNEE THI,20027301,CDM,983,RC,27301,HCPCS,outpatient,,,1903,951.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXC TUMOR THIGH OR KNEE SUBC,20027327,CDM,983,RC,27327,HCPCS,outpatient,,,1274,637,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RADICAL RESEC TUMOR SOFT TISSUE THIGH,20027329,CDM,983,RC,27329,HCPCS,outpatient,,,5693,2846.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ARTHROTOMY W SYNOVECTOMY KNEE ANT POS,20027335,CDM,983,RC,27335,HCPCS,outpatient,,,4003.25,2001.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION TUM SOFT TIS THIGH SUBQ 3CM>,20027337,CDM,983,RC,27337,HCPCS,outpatient,,,1125,562.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION PREPATELLAR BURSA,20027340,CDM,983,RC,27340,HCPCS,outpatient,,,1721.75,860.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PARTIAL EXCISION BONE,20027360,CDM,983,RC,27360,HCPCS,outpatient,,,3523.5,1761.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LATERAL RETICULAR RELEASE OPEN,20027425,CDM,983,RC,27425,HCPCS,outpatient,,,3688.5,1844.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT FEMORAL SHAFT FX WO MANIP,20027500,CDM,983,RC,27500,HCPCS,outpatient,,,1471.25,735.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT SUPRACONDYLAR FX,20027501,CDM,983,RC,27501,HCPCS,outpatient,,,2105.5,1052.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT FEMORAL SHAFT FX W MANIP,20027502,CDM,983,RC,27502,HCPCS,outpatient,,,3118.25,1559.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT SUPRACONDYLAR FX,20027503,CDM,983,RC,27503,HCPCS,outpatient,,,3086.25,1543.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OPEN TRT FEMORAL SHAFT FX,20027506,CDM,983,RC,27506,HCPCS,outpatient,,,5772.75,2886.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT FEMORAL FX WO MANIP,20027508,CDM,983,RC,27508,HCPCS,outpatient,,,1727,863.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT TIBIAL FX WO MANIP,20027530,CDM,983,RC,27530,HCPCS,outpatient,,,1071.5,535.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OPEN TRT TIBIAL FX PROXIMAL,20027535,CDM,983,RC,27535,HCPCS,outpatient,,,3907.25,1953.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OPEN TRT TIBIAL FX PROXIMAL BICONDYLA,20027536,CDM,983,RC,27536,HCPCS,outpatient,,,4669.5,2334.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT INTERCONDYLAR SPINE,20027538,CDM,983,RC,27538,HCPCS,outpatient,,,1567,783.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT KNEE DISLOCATION W ANESTH,20027552,CDM,983,RC,27552,HCPCS,outpatient,,,1833.5,916.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OPEN TRT KNEE DISLOCATION,20027556,CDM,983,RC,27556,HCPCS,outpatient,,,4467,2233.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OPEN TRT KNEE DISLOCATION W REPAIR,20027558,CDM,983,RC,27558,HCPCS,outpatient,,,5213.25,2606.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT PATELLAR DISLOC WO ANES,20027560,CDM,983,RC,27560,HCPCS,outpatient,,,879.5,439.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS MANIP KNEE JT UNDER FEN ANESTH,20027570,CDM,983,RC,27570,HCPCS,outpatient,,,831.75,415.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS AMPUTATION THIGH THRU FEMOR ANY LEVEL,20027590,CDM,983,RC,27590,HCPCS,outpatient,,,3475.5,1737.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS AMPUTATION THIGH/FEMOR ANY LEVEL 2ND,20027594,CDM,983,RC,27594,HCPCS,outpatient,,,1114,557,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS AMPUTATION THIGH/FEMOR ANY LEV REAMP,20027596,CDM,983,RC,27596,HCPCS,outpatient,,,3145,1572.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DECOMPRESSION FASCIOTOMY LEG ANT,20027602,CDM,983,RC,27602,HCPCS,outpatient,,,2302.75,1151.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RPR FLEXOR TENDON LEG PRIMARY,20027658,CDM,983,RC,27658,HCPCS,outpatient,,,1993.5,996.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RPR PRIMARY DISTUPTED LIGAMENT ANKLE,20027695,CDM,983,RC,27695,HCPCS,outpatient,,,2665.25,1332.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REMOVAL OF ANKLE IMPLANT,20027704,CDM,983,RC,27704,HCPCS,outpatient,,,2238.75,1119.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT TIBIAL SHAFT WO MANIP,20027750,CDM,983,RC,27750,HCPCS,outpatient,,,922.25,461.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT TIBIAL SHAFT W MANIP,20027752,CDM,983,RC,27752,HCPCS,outpatient,,,2025.5,1012.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OPEN TRT TIBIAL SHAFT W WO  MANIP,20027758,CDM,983,RC,27758,HCPCS,outpatient,,,4232.25,2116.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS TRT TIBIAL SHAFT FX,20027759,CDM,983,RC,27759,HCPCS,outpatient,,,4728,2364,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT MEDIAL MALLEOLUS FX WO MANIP,20027760,CDM,983,RC,27760,HCPCS,outpatient,,,879.5,439.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OPEN TRT MEDIAL MALLEOLUS FX,20027766,CDM,983,RC,27766,HCPCS,outpatient,,,2766.5,1383.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD  TRT PROXIMAL FIBULA SHAFT FX WO,20027780,CDM,983,RC,27780,HCPCS,outpatient,,,783.5,391.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD  TRT DISTAL FIBULAR FX,20027786,CDM,983,RC,27786,HCPCS,outpatient,,,837,418.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD  TRT BIMALLEOLAR ANKLE FX,20027808,CDM,983,RC,27808,HCPCS,outpatient,,,874.25,437.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OPEN  TRT BIMALLEOLAR ANKLE FX,20027814,CDM,983,RC,27814,HCPCS,outpatient,,,2132.25,1066.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OPEN  TRT BIMALLEOLAR ANKLE FX W MANI,20027818,CDM,983,RC,27818,HCPCS,outpatient,,,2004.5,1002.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OPEN TRT TRIMALLEOLAR ANKLE,20027822,CDM,983,RC,27822,HCPCS,outpatient,,,3923.25,1961.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OPEN TRT TRIMALLEOLAR ANKLE W FIX,20027823,CDM,983,RC,27823,HCPCS,outpatient,,,4547,2273.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT DISTAL TIB W SKEL TRACT,20027825,CDM,983,RC,27825,HCPCS,outpatient,,,2276,1138,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OPEN TRT DISTAL TIB JT,20027829,CDM,983,RC,27829,HCPCS,outpatient,,,2537.5,1268.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT ANKLE DISLOCATION,20027840,CDM,983,RC,27840,HCPCS,outpatient,,,1018.25,509.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS AMPUTATION LEG SEC CLOSURE REVISION,20027884,CDM,983,RC,27884,HCPCS,outpatient,,,1961.75,980.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DECOMPRESSION FASCIOTOMY POSTERIOR CO,20027893,CDM,983,RC,27893,HCPCS,outpatient,,,2153.5,1076.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS FASCIOTOMY FOOT AND/OR TOE,20028008,CDM,983,RC,28008,HCPCS,outpatient,,,1433.75,716.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION OF LESION TENDON /SHEATH,20028090,CDM,983,RC,28090,HCPCS,outpatient,,,869,434.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"GS REMOVAL OF FOREIGN BODY, FOOT SUBC",20028190,CDM,983,RC,28190,HCPCS,outpatient,,,559.75,279.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"GS REMOVAL OF FOREIGN BODY, FOOT DEEP",20028192,CDM,983,RC,28192,HCPCS,outpatient,,,1162.25,581.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REPAIR TENDON EXTENSOR FOOT EA,20028208,CDM,983,RC,28208,HCPCS,outpatient,,,1322,661,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CORRECTION HAMMERTOE,20028285,CDM,983,RC,28285,HCPCS,outpatient,,,1625.75,812.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OSTEOTOMY METATARSAL NOT FIRST EA,20028308,CDM,983,RC,28308,HCPCS,outpatient,,,1865.75,932.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OSTEOTOMY PROXIMAL PHALANX FIRST TOE,20028310,CDM,983,RC,28310,HCPCS,outpatient,,,1689.75,844.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RECONSTR DEFORM TOE SOFT TISSUE,20028313,CDM,983,RC,28313,HCPCS,outpatient,,,1578,789,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT CALCANEAL FX WO MANIP,20028400,CDM,983,RC,28400,HCPCS,outpatient,,,661,330.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS TRT TARSAL BONE FX WO MANIP,20028450,CDM,983,RC,28450,HCPCS,outpatient,,,570.5,285.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT METATARSAL FX WO MANIP,20028470,CDM,983,RC,28470,HCPCS,outpatient,,,458.75,229.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT FX GREAT TOE,20028490,CDM,983,RC,28490,HCPCS,outpatient,,,362.75,181.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PERCUTANEOUS SKELETAL FIX GRERAT TOE,20028496,CDM,983,RC,28496,HCPCS,outpatient,,,1236.75,618.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OPEN TRT FX GREAT TOE PHALANX,20028505,CDM,983,RC,28505,HCPCS,outpatient,,,1562,781,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT FX  PHALANX PHALANGES WO MAN,20028510,CDM,983,RC,28510,HCPCS,outpatient,,,320,160,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT FX  PHALANX PHALANGES W MAN,20028515,CDM,983,RC,28515,HCPCS,outpatient,,,485.25,242.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OPEN TRT FX  PHALANX PHALANGES,20028525,CDM,983,RC,28525,HCPCS,outpatient,,,1343.25,671.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT SESAMOID FX,20028530,CDM,983,RC,28530,HCPCS,outpatient,,,522.5,261.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS AMPUTATION METATARSAL WITH TOE SINGLE,20028810,CDM,983,RC,28805,HCPCS,outpatient,,,1721.75,860.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS AMPUTATION TOE METATARSOPHALANGEAL JT,20028820,CDM,983,RC,28820,HCPCS,outpatient,,,1402,701,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS AMPUTATION TOE INTERPHALANGEAL JT,20028825,CDM,983,RC,28825,HCPCS,outpatient,,,1306,653,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS APPLICATION OF HIP SPICA CAST ONE LEG,20029305,CDM,983,RC,29305,HCPCS,outpatient,,,709,354.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS APPLICATION OF HIP SPICA CAST 1.5/2,20029325,CDM,983,RC,29325,HCPCS,outpatient,,,900.75,450.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS APPLICATION OF SHORT LEG CAST WALKING,20029425,CDM,983,RC,29425,HCPCS,outpatient,,,272,136,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ADDING WALKER TO PREV APP CAST,20029440,CDM,983,RC,29440,HCPCS,outpatient,,,128,64,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS STRAPPING UN BOOT (APPLICATION),20029580,CDM,983,RC,29580,HCPCS,outpatient,,,170.75,85.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REMOVAL BIVALVING FULL ARM OR LEG CAS,20029705,CDM,983,RC,29705,HCPCS,outpatient,,,224,112,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ARTHROSCOPY SHOULDER LYSIS RESEC,20029825,CDM,983,RC,29825,HCPCS,outpatient,,,3496.75,1748.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Shaving of shoulder bone using an endoscope,20029826,CDM,983,RC,29826,HCPCS,outpatient,,,4349.75,2174.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ARTHROSCOPY KNEE DIAG,20029870,CDM,983,RC,29870,HCPCS,outpatient,,,1929.5,964.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ARTHROSCOPY KNEE SYNOVECTOMY LTD,20029875,CDM,983,RC,29875,HCPCS,outpatient,,,3475.5,1737.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ARTHROSCOPY KNEE SYNOVECTOMY MAJ,20029876,CDM,983,RC,29876,HCPCS,outpatient,,,4221.75,2110.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ARTHROSCOPY KNEE SYNOVECTOMY DEB,20029877,CDM,983,RC,29877,HCPCS,outpatient,,,1807,903.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Surgery to remove of all or part of a torn meniscus in one compartment,20029881,CDM,983,RC,29881,HCPCS,outpatient,,,1892.25,946.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ARTHROSCOPY KNEE SYNOVECTOMY DRILL,20029886,CDM,983,RC,29886,HCPCS,outpatient,,,4141.75,2070.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REMOVE FOR BODY INTRASAL,20030300,CDM,983,RC,30300,HCPCS,outpatient,,,490.5,245.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CONTROL SAL HEMORRHAGE ANT COMP,20030905,CDM,983,RC,30905,HCPCS,outpatient,,,698.5,349.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INTUBATION ENDOTRACH EMERG PROCED,20031500,CDM,983,RC,31500,HCPCS,outpatient,,,261.25,130.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS TRACH TUBE CHANGE PRIOR TO FISTULA TR,20031502,CDM,983,RC,31502,HCPCS,outpatient,,,266.75,133.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS TRACHEOSTOMY PLANNED,20031600,CDM,983,RC,31600,HCPCS,outpatient,,,1513.75,756.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REVISION OF TRACHEOSTOMY SCAR,20031830,CDM,983,RC,31830,HCPCS,outpatient,,,1391.5,695.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS THORACOTOMY REMOVAL INTRAPLEUR,20032150,CDM,983,RC,32150,HCPCS,outpatient,,,3875.25,1937.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS TUBE THORACOSTOMY LT,20032551,CDM,983,RC,32551,HCPCS,outpatient,,,592,296,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INSERT TRANS ELECTRODE PERM PLACE IMP,20033216,CDM,983,RC,33216,HCPCS,outpatient,,,1785.75,892.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REPAIR BLOOD VESSEL HAND FINGER,20035207,CDM,983,RC,35207,HCPCS,outpatient,,,4637.5,2318.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REPAIR BLOOD VESSEL VEIN GRAFT UPPER,20035236,CDM,983,RC,35236,HCPCS,outpatient,,,4472,2236,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXPLORE POSTOP HEMM ABDOMEN,20035840,CDM,960,RC,35840,HCPCS,outpatient,,,2015,1007.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REMOVAL IMPLANTED INTRA-ARTERIAL PUMP,20036262,CDM,983,RC,36262,HCPCS,outpatient,,,725.25,362.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS VENIPUNCTURE 3 YR OR > SKILL OF MD,20036410,CDM,983,RC,36410,HCPCS,outpatient,,,42.75,21.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Collection of venous blood by venipuncture,20036415,CDM,983,RC,36415,HCPCS,outpatient,,,26.75,13.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SINGLE MULTI INJ (SPIDER VEIN(S)),20036468,CDM,983,RC,36468,HCPCS,outpatient,,,106.75,53.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SCLEROTHERAPY SINGLE VEIN,20036470,CDM,983,RC,36470,HCPCS,outpatient,,,258.75,129.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Injections to remove spider veins on the limbs or trunk,20036471,CDM,983,RC,36471,HCPCS,outpatient,,,310.5,155.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Ablation of incompetent vein,20036475,CDM,983,RC,36475,HCPCS,outpatient,,,7462.5,3731.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Laser removal of incompetent vein,20036478,CDM,983,RC,36478,HCPCS,outpatient,,,719.75,359.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EVLT LASER SUBSEQ VEIN +,20036479,CDM,983,RC,36479,HCPCS,outpatient,,,353.75,176.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ENDOVENOUS ABLATION TX INCOMP EXTREMI,20036482,CDM,983,RC,36482,HCPCS,outpatient,,,464.25,232.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INSERTION NON-TUNNELED VENOUS CATH,20036556,CDM,983,RC,36556,HCPCS,outpatient,,,682.5,341.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INSERTION TUNNELED CENTRALLY INSERTED,20036558,CDM,983,RC,36558,HCPCS,outpatient,,,2286.75,1143.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INSERTION CVAD W/PORT 5YR OR >,20036561,CDM,983,RC,36561,HCPCS,outpatient,,,3262.25,1631.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INSERTION PERIPHERAL CENTRAL VAD W/O,20036569,CDM,983,RC,36569,HCPCS,outpatient,,,309.25,154.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CATH REMOVAL TUNNELED W/O PUMP,20036589,CDM,983,RC,36589,HCPCS,outpatient,,,512,256,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CATH REMOVAL TUNNELED W PUMP,20036590,CDM,983,RC,36590,HCPCS,outpatient,,,831.75,415.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ARTERIAL PUNCTURE WITHDRAWAL BLOOD DG,20036600,CDM,983,RC,36600,HCPCS,outpatient,,,69.5,34.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ART CATH PERCUTANEOUS,20036620,CDM,983,RC,36620,HCPCS,outpatient,,,122.75,61.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LIGATION OR BIOPSY TEMPORAL ARTERY,20037609,CDM,983,RC,37609,HCPCS,outpatient,,,975.5,487.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LIGATION MAJ ARTERY EXTREMITY,20037618,CDM,983,RC,37618,HCPCS,outpatient,,,1871.25,935.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LIGATION DIV LONG SAPHENOUS VEIN,20037700,CDM,983,RC,37700,HCPCS,outpatient,,,1535.25,767.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LIGATION OF PERFORATOR VEINS OPEN,20037760,CDM,983,RC,37760,HCPCS,outpatient,,,3571.5,1785.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS STAB LIGATION 10-20,20037765,CDM,983,RC,37765,HCPCS,outpatient,,,1386,693,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS STAB LIGATION 20+,20037766,CDM,983,RC,37766,HCPCS,outpatient,,,1684.5,842.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LIGATION & DIVISION SHORT SAPHEROUS V,20037780,CDM,983,RC,37780,HCPCS,outpatient,,,490.5,245.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LIGATION EXCIS VARIX CLUSTER 1 LEG,20037785,CDM,983,RC,37785,HCPCS,outpatient,,,778.5,389.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS STAB PHLEBECTOMY VARICOSE VEINS LESS,20037799,CDM,983,RC,37799,HCPCS,outpatient,,,240,120,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REMOVAL OF SPLEEN TOTAL,20038100,CDM,983,RC,38100,HCPCS,outpatient,,,3326,1663,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SPLEENECTOMY TOTAL DISEASE,20038102,CDM,983,RC,38102,HCPCS,outpatient,,,821,410.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPROSCOPY SURGICAL SPLEENECTOMY,20038120,CDM,983,RC,38120,HCPCS,outpatient,,,3107.75,1553.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS BIOPSY EXCISION LYMPH NODE OPEN,20038500,CDM,983,RC,38500,HCPCS,outpatient,,,900.75,450.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS BIOPSY EXCISION LYMPH NODE OPEN DEEP,20038510,CDM,983,RC,38510,HCPCS,outpatient,,,1460.5,730.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS BIOPSY EXCISION LYMPH NODE OPEN DEEP,20038525,CDM,983,RC,38525,HCPCS,outpatient,,,1236.75,618.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LTD LYMPHADENECTOMY PELVIC PARAAORTIC,20038562,CDM,983,RC,38562,HCPCS,outpatient,,,2089.5,1044.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CERVICAL LYMPHADENECTOMY,20038724,CDM,983,RC,38724,HCPCS,outpatient,,,6439,3219.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ABDOMIL LYMPHADENECTOMY,20038747,CDM,983,RC,38747,HCPCS,outpatient,,,1689.75,844.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INGUINOFEMORAL LYMPHADENECTOMY,20038760,CDM,983,RC,38760,HCPCS,outpatient,,,3161,1580.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INJ RADIOACTIVE TRACER FOR SENTINEL N,20038792,CDM,983,RC,38792,HCPCS,outpatient,,,69.5,34.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INTRAOPERATIVE ID SENT LYMPH W/INJECT,20038900,CDM,983,RC,38900,HCPCS,outpatient,,,320,160,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INCISION OF LABIAL FRENUM,20040806,CDM,983,RC,40806,HCPCS,outpatient,,,224,112,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION LESION MUCOSA,20040810,CDM,983,RC,40810,HCPCS,outpatient,,,458.75,229.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION FRENUM LABIAL BUCCAL,20040819,CDM,983,RC,40819,HCPCS,outpatient,,,687.5,343.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DESTRUCTION LESION OR SCAR,20040820,CDM,983,RC,40820,HCPCS,outpatient,,,559.75,279.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INCISION LINGUAL FRENUM,20041010,CDM,983,RC,41010,HCPCS,outpatient,,,485.25,242.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION TONGUE LESION,20041110,CDM,983,RC,41110,HCPCS,outpatient,,,479.75,239.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION TONGUE LESION POSTERIOR THIR,20041113,CDM,983,RC,41113,HCPCS,outpatient,,,1114,557,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION LINGUAL FRENUM,20041115,CDM,983,RC,41115,HCPCS,outpatient,,,639.75,319.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DRAIGE ABSCESS PAROTID COMPLICATED,20042305,CDM,983,RC,42305,HCPCS,outpatient,,,1929.5,964.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DRAIGE ABSCESS SUBMAXILLARY EXT,20042320,CDM,983,RC,42320,HCPCS,outpatient,,,1002.25,501.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS BIOPSY SALIVARY GLAND INCISIOL,20042405,CDM,983,RC,42405,HCPCS,outpatient,,,863.5,431.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INCISION AND DRAIGE ABSCESS PERITON,20042700,CDM,983,RC,42700,HCPCS,outpatient,,,527.75,263.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of tonsils and adenoid glands patient younger than age 12,20042820,CDM,983,RC,42820,HCPCS,outpatient,,,1375.5,687.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS TONSILLECTOMY ADENOIDECTOMY > 12 YR,20042821,CDM,983,RC,42821,HCPCS,outpatient,,,1487.25,743.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS TONSILLECTOMY PRIM OR SECOND < 12 YR,20042825,CDM,983,RC,42825,HCPCS,outpatient,,,1268.75,634.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Primary or secondary removal of tonsils,20042826,CDM,983,RC,42826,HCPCS,outpatient,,,1396.5,698.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ADENOIDECTOMY > 12,20042831,CDM,983,RC,42831,HCPCS,outpatient,,,1023.5,511.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CONTROL OROPHARYNGEAL HEMORRHAGE,20042962,CDM,983,RC,42962,HCPCS,outpatient,,,1508.75,754.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ESOPHAGOSCOPY DIAG,20043200,CDM,983,RC,43200,HCPCS,outpatient,,,586.5,293.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ESOPHAGOSCOPY FLEX TRANSORAL W/ BX,20043202,CDM,983,RC,43202,HCPCS,outpatient,,,209.5,104.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ESOPHAGOSCOPY FLEX TRANS DIAG R FB,20043215,CDM,983,RC,43215,HCPCS,outpatient,,,341.25,170.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Diagnostic examition of esophagus, stomach, and/or upper small bowel using an endoscope",20043235,CDM,983,RC,43235,HCPCS,outpatient,,,597,298.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",20043239,CDM,983,RC,43239,HCPCS,outpatient,,,693,346.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS UPPER GASTROINTESTIL ENDOSCOPY TRAN,20043241,CDM,983,RC,43241,HCPCS,outpatient,,,346.5,173.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS UPPER GASTROINTESTIL ENDOSCOPY DIL,20043245,CDM,983,RC,43245,HCPCS,outpatient,,,416,208,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS UPPER GASTROINTESTIL ENDOSCOPY,20043246,CDM,983,RC,43246,HCPCS,outpatient,,,559.75,279.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ESOPHAGOSCOPY FLEX TRAN DIAG R FB,20043247,CDM,983,RC,43247,HCPCS,outpatient,,,447.75,223.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EGD W BALLOON DIL ESOPH,20043249,CDM,983,RC,43249,HCPCS,outpatient,,,389.25,194.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ESOPHAGOSCOPY FLEX TRANS DIAG W TUMOR,20043250,CDM,983,RC,43250,HCPCS,outpatient,,,416,208,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS UPPER GASTROINTESTIL ENDOSCOPY,20043251,CDM,983,RC,43251,HCPCS,outpatient,,,485.25,242.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS UPPER GASTROINTESTIL ENDOSCOPY,20043255,CDM,983,RC,43255,HCPCS,outpatient,,,629.25,314.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ENDOSCOPIC RETROGRADE CHOLANGIO,20043261,CDM,983,RC,43261,HCPCS,outpatient,,,810.25,405.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPROSCOPY SURGINCAL ESOPH FUNDOPLAST,20043280,CDM,983,RC,43280,HCPCS,outpatient,,,3219.5,1609.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPAROSCOPY SURGICAL REPAIR PARAESO,20043281,CDM,983,RC,43281,HCPCS,outpatient,,,4936,2468,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DILATION OF ESOPHAGUS OVER GUIDE WIRE,20043453,CDM,983,RC,43453,HCPCS,outpatient,,,592,296,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ESOPHAGOGASTRIC TAMPODE W BALLOON,20043460,CDM,983,RC,43460,HCPCS,outpatient,,,597,298.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PYLOROMYOTOMY CUTTING PYLORIC MUSCLE,20043520,CDM,983,RC,43520,HCPCS,outpatient,,,3022.25,1511.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION LOCAL ULCER OR BENIGH TUMOR,20043610,CDM,983,RC,43610,HCPCS,outpatient,,,2878.5,1439.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS GASTRECTOMY WITH GASTROJEJUNOSTOMY,20043632,CDM,983,RC,43632,HCPCS,outpatient,,,5943.25,2971.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPROSCOPY SURGICAL TRANSECTION VAGUS,20043651,CDM,983,RC,43651,HCPCS,outpatient,,,1908.5,954.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPROSCOPY SURGICAL TRANSECTION VAGUS,20043652,CDM,983,RC,43652,HCPCS,outpatient,,,2233.5,1116.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPROSCOPY SURGICAL GASTROSTOMY,20043653,CDM,983,RC,43653,HCPCS,outpatient,,,1609.75,804.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REPOSITIONING GASTRIC FEEDING TUBE,20043761,CDM,983,RC,43761,HCPCS,outpatient,,,272,136,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPAROSCOPY SURGICAL GASTRIC RESTRICT,20043770,CDM,983,RC,43770,HCPCS,outpatient,,,3251.5,1625.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPAROSCOPY REVIS OF ADJ GASTRIC RE,20043771,CDM,983,RC,43771,HCPCS,outpatient,,,3720.75,1860.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS GASTROJEJUNOSTOMY WO VAGOTOMY,20043820,CDM,983,RC,43820,HCPCS,outpatient,,,3795.25,1897.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS GASTROJTOMY OPEN WO GASTRIC TUBE,20043830,CDM,983,RC,43830,HCPCS,outpatient,,,2004.5,1002.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REVISION GASTROJEJUL ASTOMOSIS,20043865,CDM,983,RC,43865,HCPCS,outpatient,,,5042.75,2521.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DILATION OF STRICTURE OF STOMACH,20043999,CDM,983,RC,43999,HCPCS,outpatient,,,394.5,197.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ENTEROLYSIS,20044005,CDM,983,RC,44005,HCPCS,outpatient,,,3699.25,1849.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS TUBE OR NEEDLE CATHETER JEJUNOSTOMY,20044015,CDM,983,RC,44015,HCPCS,outpatient,,,453.25,226.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ENTEROTOMY SMALL INTESTINE,20044020,CDM,983,RC,44020,HCPCS,outpatient,,,3182.25,1591.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS COLOTOMY EXPLORE BIOPSY FOR BODY,20044025,CDM,983,RC,44025,HCPCS,outpatient,,,3576.75,1788.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REDUCTION VOLVULUS INTUSSUSCEPTION,20044050,CDM,983,RC,44050,HCPCS,outpatient,,,2692,1346,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION ONE OR MORE LESION INTESTINE,20044110,CDM,983,RC,44110,HCPCS,outpatient,,,2473.25,1236.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ENTERECTOMY RESECTION OF SMALL INTEST,20044120,CDM,983,RC,44120,HCPCS,outpatient,,,3576.75,1788.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ENTERECTOMY RESECTION OF SMALL INTEST,20044121,CDM,983,RC,44121,HCPCS,outpatient,,,757,378.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS MOBILIZATION OF SPLENIC FLEXURE COLEC,20044139,CDM,983,RC,44139,HCPCS,outpatient,,,378.75,189.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS COLECTOMY PARTIAL W ASTOMOSIS,20044140,CDM,983,RC,44140,HCPCS,outpatient,,,3965.75,1982.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS COLECTOMY PARTIAL W ASTOMOSIS,20044141,CDM,983,RC,44141,HCPCS,outpatient,,,4946.75,2473.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS COLECTOMY PARTIAL W ASTOMOSIS,20044143,CDM,983,RC,44143,HCPCS,outpatient,,,4856,2428,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS COLECTOMY PARTIAL W ASTOMOSIS,20044144,CDM,983,RC,44144,HCPCS,outpatient,,,5037.25,2518.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS COLECTOMY PARTIAL W ASTOMOSIS,20044145,CDM,983,RC,44145,HCPCS,outpatient,,,5911.25,2955.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS COLECTOMY TOTAL ABDOMIL,20044150,CDM,983,RC,44150,HCPCS,outpatient,,,5495.75,2747.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS COLECTOMY PARTIAL TERM ILEUM,20044160,CDM,983,RC,44160,HCPCS,outpatient,,,3646,1823,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPAROSCOPY SURGICAL ENTEROLYSIS,20044180,CDM,983,RC,44180,HCPCS,outpatient,,,2724,1362,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPAROSCOPY SURGICAL ENTERECTOMY,20044202,CDM,983,RC,44202,HCPCS,outpatient,,,4109.75,2054.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPAROSCOPY COLECTOMY PARTIAL W AS,20044204,CDM,983,RC,44204,HCPCS,outpatient,,,4584.25,2292.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAP COLECTOMY PARTIAL W REMOVAL,20044205,CDM,983,RC,44205,HCPCS,outpatient,,,4104.5,2052.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAP MOBILIZATION SPLENIC FLEXURE W/CO,20044213,CDM,983,RC,44213,HCPCS,outpatient,,,543.75,271.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PLACEMENT ENTEROSTOMY CECOSTOMY TUBE,20044300,CDM,983,RC,44300,HCPCS,outpatient,,,2601.25,1300.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ILEOSTOMY OR JEJUNOSTOMY NON TUBE,20044310,CDM,983,RC,44310,HCPCS,outpatient,,,3464.75,1732.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REVISION ILEOSTOMY SIMPLE,20044312,CDM,983,RC,44312,HCPCS,outpatient,,,1658,829,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REVISION ILEOSTOMY COMPLICATED,20044314,CDM,983,RC,44314,HCPCS,outpatient,,,3299.5,1649.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REVISION COLOSTOMY COMPLICATED,20044345,CDM,983,RC,44345,HCPCS,outpatient,,,3059.5,1529.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SMALL INTESTIL ENDO W BIOP SING MUL,20044361,CDM,983,RC,44361,HCPCS,outpatient,,,383.75,191.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SMALL INTESTIL ENDOSCOPY ENTEROSCOP,20044376,CDM,983,RC,44376,HCPCS,outpatient,,,629.25,314.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ENDOSCOPIC EVAL SMALL INTEST POUCH DI,20044385,CDM,983,RC,44385,HCPCS,outpatient,,,330.5,165.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Diagnostic examition of large bowel using an endoscope which is inserted through abdomil opening,20044388,CDM,983,RC,44388,HCPCS,outpatient,,,517,258.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SUTURE SMALL INTESTINE FOR PERFORATED,20044602,CDM,983,RC,44602,HCPCS,outpatient,,,4035,2017.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SUTURE SMALL INTESTINE FOR PERFORATED,20044603,CDM,983,RC,44603,HCPCS,outpatient,,,4621.5,2310.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SUTURE LGE INTESTINE FOR PERFORATED,20044604,CDM,983,RC,44604,HCPCS,outpatient,,,3134.25,1567.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INTESTIL STRICTUROPLASTY,20044615,CDM,983,RC,44615,HCPCS,outpatient,,,3171.5,1585.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLOSURE ENTEROSTOMY LARGE OR SMALL IN,20044620,CDM,983,RC,44620,HCPCS,outpatient,,,2521.5,1260.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLOSURE ENTEROSTOMY LARGE OR SMALL IN,20044625,CDM,983,RC,44625,HCPCS,outpatient,,,2995.75,1497.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLOSURE INTESTIL CUTANEOUS FISTULA,20044640,CDM,983,RC,44640,HCPCS,outpatient,,,4173.75,2086.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS UNLISTED PROCEDURE SMALL INTESTINE,20044799,CDM,983,RC,44799,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION MECKELS DIVERTICULUM,20044800,CDM,983,RC,44800,HCPCS,outpatient,,,2217.5,1108.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INC & DRAIN APPENDICEAL ABSCESS,20044900,CDM,983,RC,44900,HCPCS,outpatient,,,2212.25,1106.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS APPENDECTOMY,20044950,CDM,983,RC,44950,HCPCS,outpatient,,,1892.25,946.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS APPENDECTOMY SECONDARY PROC,20044955,CDM,983,RC,44955,HCPCS,outpatient,,,261.25,130.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS APPENDECTOMY RUPTURED ABSCESS,20044960,CDM,983,RC,44960,HCPCS,outpatient,,,2537.5,1268.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPROSCOPY SURGICAL APPENDECTOMY,20044970,CDM,983,RC,44970,HCPCS,outpatient,,,1727,863.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAP APPENDECTOMY AT TIME OF MAJ PROCE,20044979,CDM,983,RC,44979,HCPCS,outpatient,,,890.25,445.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS BIOP ANORECTAL WALL; AL APPROACH,20045100,CDM,983,RC,45100,HCPCS,outpatient,,,767.5,383.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PROCTECTOMY COMPLETE ABDOM,20045110,CDM,983,RC,45110,HCPCS,outpatient,,,6369.75,3184.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION OF RECTAL PROCIDENTIAL W ANO,20045130,CDM,983,RC,45130,HCPCS,outpatient,,,3283.75,1641.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"GS EXC RECTAL TUMOR, TRANSAL APPROACH",20045171,CDM,983,RC,45171,HCPCS,outpatient,,,1812.5,906.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PROCTOSIGMOIDOSCOPY RIGID DIAG,20045300,CDM,983,RC,45300,HCPCS,outpatient,,,287.75,143.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PROCTO BIOPSY,20045305,CDM,983,RC,45305,HCPCS,outpatient,,,469.25,234.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PROCTOSIGMOIDOSCOPY RIGID SINGLE TUM,20045309,CDM,983,RC,45309,HCPCS,outpatient,,,655.75,327.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SIGMOIDOSCOPY FLEXIBLE DIAG INC SPECI,20045330,CDM,983,RC,45330,HCPCS,outpatient,,,138.75,69.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SIGMOIDOSCOPY FLEXIBLE W BIOPSY,20045331,CDM,983,RC,45331,HCPCS,outpatient,,,336,168,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SIGMOIDOSCOPY FLEX DIAG SPEC REMOV FB,20045332,CDM,983,RC,45332,HCPCS,outpatient,,,549.25,274.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SIGMOIDOSCOPY FLEX DIAG W HOT FORCEPS,20045333,CDM,983,RC,45333,HCPCS,outpatient,,,549.25,274.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SIGMOIDOSCOPY FLEX DIAG W CONTR BLEED,20045334,CDM,983,RC,45334,HCPCS,outpatient,,,362.75,181.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SIGMOIDOSCOPY FLEXIBLE REMOVAL,20045338,CDM,983,RC,45338,HCPCS,outpatient,,,623.75,311.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Diagnostic examition of large bowel using an endoscope,20045378,CDM,983,RC,45378,HCPCS,outpatient,,,794.25,397.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of foreign bodies in large bowel using an endoscope,20045379,CDM,983,RC,45379,HCPCS,outpatient,,,1007.5,503.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Biopsy of large bowel using an endoscope,20045380,CDM,983,RC,45380,HCPCS,outpatient,,,1204.75,602.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Injections of large bowel using an endoscope,20045381,CDM,983,RC,45381,HCPCS,outpatient,,,709,354.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of polyps or growths in large bowel using an endoscope,20045384,CDM,983,RC,45384,HCPCS,outpatient,,,943.5,471.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of polyps or growths of large bowel using an endoscope,20045385,CDM,983,RC,45385,HCPCS,outpatient,,,1082.25,541.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of large bowel growths using an endoscope,20045388,CDM,983,RC,45388,HCPCS,outpatient,,,922.25,461.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PROCTOPEXY PERINEAL APPROACH,20045541,CDM,983,RC,45541,HCPCS,outpatient,,,4179,2089.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DILATION OF RECTAL STRICTURE UNDER AN,20045910,CDM,983,RC,45910,HCPCS,outpatient,,,565.25,282.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REMOVAL FECAL IMPACTION FB UNDER ANES,20045915,CDM,983,RC,45915,HCPCS,outpatient,,,671.75,335.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ANORECTAL EXAM SURGICAL ANES DIAG,20045990,CDM,983,RC,45990,HCPCS,outpatient,,,325.25,162.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ELECTROCAUTERY/SUTURE RECTAL ULCER,20045999,CDM,983,RC,45999,HCPCS,outpatient,,,1828.5,914.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INC & DRAIN ISCHIORECTAL,20046040,CDM,983,RC,46040,HCPCS,outpatient,,,1188.75,594.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INC & DRAIN INTRAMURAL,20046045,CDM,983,RC,46045,HCPCS,outpatient,,,1103.5,551.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INC & DRAIN PERIAL ABSCESS,20046050,CDM,983,RC,46050,HCPCS,outpatient,,,432,216,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INC & DRAIN ISCHIORECTAL,20046060,CDM,983,RC,46060,HCPCS,outpatient,,,2201.5,1100.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INC THROMBOSED HEMORRHOID EXT,20046083,CDM,983,RC,46083,HCPCS,outpatient,,,453.25,226.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS AL FISSURE EXCISION,20046200,CDM,983,RC,46200,HCPCS,outpatient,,,506.5,253.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PAPILLECTOMY OR EXCISION SNGL TAG,20046220,CDM,983,RC,46220,HCPCS,outpatient,,,378.75,189.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS HEMORRHOIDECTOMY SIMPLE LIGATURE,20046221,CDM,983,RC,46221,HCPCS,outpatient,,,474.5,237.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION EXT HEMORRHOID,20046230,CDM,983,RC,46230,HCPCS,outpatient,,,607.75,303.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS HEMORRHOIDECTOMY EXT >=2,20046250,CDM,983,RC,46250,HCPCS,outpatient,,,1359.25,679.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS HEMORRHOIDECTOMY INTAND EXT COMP,20046255,CDM,983,RC,46255,HCPCS,outpatient,,,1817.75,908.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS HEMORRHOIDECTOMY FISSURECTOMY,20046257,CDM,983,RC,46257,HCPCS,outpatient,,,1983,991.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS HEMORRHOIDECTOMY EXTENSIVE,20046260,CDM,983,RC,46260,HCPCS,outpatient,,,1306,653,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS HEMORRHOIDECTOMY FISSURECTOMY,20046261,CDM,983,RC,46261,HCPCS,outpatient,,,2734.5,1367.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SURGICAL TREATMENT AL FISSURE,20046270,CDM,983,RC,46270,HCPCS,outpatient,,,1268.75,634.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SURGICAL TRT AL FISSURE SUBMUSC,20046275,CDM,983,RC,46275,HCPCS,outpatient,,,1993.5,996.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION THROMBOSED HEMORRHOID EXT,20046320,CDM,983,RC,46320,HCPCS,outpatient,,,794.25,397.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS BOTOX OF AL FISSURE,20046505,CDM,983,RC,46505,HCPCS,outpatient,,,623.75,311.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ANOSCOPY DIAG COLLECTION OF SPECIMEN,20046600,CDM,983,RC,46600,HCPCS,outpatient,,,165.5,82.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ANOSCOPY DIAG W DILATION,20046604,CDM,983,RC,46604,HCPCS,outpatient,,,783.5,391.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ANOSCOPY DIAG W BIOPSY,20046606,CDM,983,RC,46606,HCPCS,outpatient,,,346.5,173.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REPAIR AL FISTULA W/FRIBIN GLUE,20046706,CDM,983,RC,46706,HCPCS,outpatient,,,447.75,223.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DESTRUCTION LESION ANUS SIMPLE SURG E,20046922,CDM,983,RC,46922,HCPCS,outpatient,,,367.75,183.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DESTRUCTION LESION ANUS EXTENSIVE,20046924,CDM,983,RC,46924,HCPCS,outpatient,,,533.25,266.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LIGATION INTERL HEMORRHOIDS SNGLE,20046945,CDM,983,RC,46945,HCPCS,outpatient,,,650.25,325.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LIGATION INTERL HEMORRHOIDS MULTI,20046946,CDM,983,RC,46946,HCPCS,outpatient,,,746.25,373.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS HEMORRHOIDECTOMY SINGLE,20046999,CDM,983,RC,46999,HCPCS,outpatient,,,602.5,301.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"GS BIOPSY LIVER, NEEDLE, PERCUTANEOUS",20047000,CDM,983,RC,47000,HCPCS,outpatient,,,725.25,362.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"GS BIOPSY LIVER, NEEDLE, PERCUTANEOUS",20047001,CDM,983,RC,47001,HCPCS,outpatient,,,325.25,162.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS HEPATOTOMY OPEN DRAIGE ABCESS,20047010,CDM,983,RC,47010,HCPCS,outpatient,,,4253.75,2126.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS BIOPSY OF LIVER WEDGE,20047100,CDM,983,RC,47100,HCPCS,outpatient,,,2409.25,1204.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS MGMT LIVER HEMORRHAGE,20047350,CDM,983,RC,47350,HCPCS,outpatient,,,3997.75,1998.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPRO RESECTION LIVER MASS,20047379,CDM,983,RC,47379,HCPCS,outpatient,,,1103.5,551.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CHOLEDOCHOTOMY CHOLEDOCHOSTOMY,20047420,CDM,983,RC,47420,HCPCS,outpatient,,,4152.25,2076.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CHOLECYSTOTOMY OPEN WITH EXPLORATION,20047480,CDM,983,RC,47480,HCPCS,outpatient,,,2441.5,1220.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS BILIARY ENDOSCOPY INTRAOP,20047550,CDM,983,RC,47550,HCPCS,outpatient,,,762.5,381.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS BILIARY ENDOSCOPY PERCUTANEOUS,20047552,CDM,983,RC,47552,HCPCS,outpatient,,,1860.25,930.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of gallbladder using an endoscope,20047562,CDM,983,RC,47562,HCPCS,outpatient,,,2153.5,1076.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Gallbladder removal with use of an x-ray exam of the bile ducts,20047563,CDM,983,RC,47563,HCPCS,outpatient,,,2217.5,1108.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPROSCOPY SURG GUIDED TRANS CHOLECY,20047564,CDM,983,RC,47564,HCPCS,outpatient,,,2574.75,1287.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPROSCOPY CHOLECYSTECTOMY,20047570,CDM,983,RC,47570,HCPCS,outpatient,,,2292.25,1146.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CHOLECYSTECTOMY,20047600,CDM,983,RC,47600,HCPCS,outpatient,,,3075.5,1537.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CHOLECYSTECTOMY W CHOLANGIOGRAPHY,20047605,CDM,983,RC,47605,HCPCS,outpatient,,,2867.75,1433.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CHOLECYSTECTOMY W EXPLOR,20047610,CDM,983,RC,47610,HCPCS,outpatient,,,3683.5,1841.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CHOLECYSTECTOMY W TRANS,20047620,CDM,983,RC,47620,HCPCS,outpatient,,,4045.75,2022.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS BIOPSY PANCREAS OPEN,20048100,CDM,983,RC,48100,HCPCS,outpatient,,,2894.5,1447.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS BIOPSY PANCREAS PERCUTANEOUS NEEDLE,20048102,CDM,983,RC,48102,HCPCS,outpatient,,,1146,573,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"GS EXT DRAIGE, PSEUDOCYST PANCREAS OPE",20048510,CDM,983,RC,48510,HCPCS,outpatient,,,3113,1556.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXPLORATION LAPAROTOMY,20049000,CDM,983,RC,49000,HCPCS,outpatient,,,2271,1135.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REOPENING OF RECENT LAPAROTOMY,20049002,CDM,983,RC,49002,HCPCS,outpatient,,,2942.25,1471.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DRAIGE PERITONEAL ABSCESS,20049020,CDM,983,RC,49020,HCPCS,outpatient,,,4642.75,2321.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DRAIGE RETROPERITONEAL ABSCESS,20049060,CDM,983,RC,49060,HCPCS,outpatient,,,2974.5,1487.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS BIOPSY ABD RETRO MASS PERCUT NEEDLE,20049180,CDM,983,RC,49180,HCPCS,outpatient,,,741,370.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPAROSCOPY ABD PERITONEUM OMEN,20049320,CDM,983,RC,49320,HCPCS,outpatient,,,970.25,485.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPAROSCOPY SURG BIOP,20049321,CDM,983,RC,49321,HCPCS,outpatient,,,1023.5,511.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPAROSCOPY SURG BIOP W ASP,20049322,CDM,983,RC,49322,HCPCS,outpatient,,,1108.75,554.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPAROSCOPY SURG BIOP W DRAIN,20049323,CDM,983,RC,49323,HCPCS,outpatient,,,1876.25,938.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAP LYSIS ADHESIONS OF OMENTUM,20049329,CDM,983,RC,49329,HCPCS,outpatient,,,2015,1007.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RPR INITIAL INGUIL HERNIA,20049495,CDM,983,RC,49495,HCPCS,outpatient,,,2516,1258,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RPR INITIAL INGUIL HERNIA INC OR ST,20049496,CDM,983,RC,49496,HCPCS,outpatient,,,2596,1298,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RPR INITIAL INGUIL HERNIA 6M TO 5 Y,20049500,CDM,983,RC,49500,HCPCS,outpatient,,,2324.25,1162.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Repair of groin hernia patient age 5 years or older,20049505,CDM,983,RC,49505,HCPCS,outpatient,,,1498,749,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RPR INITIAL INGUIL HERNIA 5YR OLDER,20049507,CDM,983,RC,49507,HCPCS,outpatient,,,1849.75,924.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RPR RECURRENT INGUIL HERNIA RED,20049520,CDM,983,RC,49520,HCPCS,outpatient,,,1839,919.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RPR RECURRENT INGUIL HERNIA INC,20049521,CDM,983,RC,49521,HCPCS,outpatient,,,2249.5,1124.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RPR INGUIL HERNIA SLIDING ANY AGE,20049525,CDM,983,RC,49525,HCPCS,outpatient,,,1658,829,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REPAIR INITIAL FEMORAL HERNIA  REDUCI,20049550,CDM,983,RC,49550,HCPCS,outpatient,,,1721.75,860.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RPR INITIAL FEMORAL HERNIA INC,20049553,CDM,983,RC,49553,HCPCS,outpatient,,,1828.5,914.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RPR REC FEMORAL HERNIA,20049555,CDM,983,RC,49555,HCPCS,outpatient,,,1738,869,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RPRRECURRENT FEMORAL HERNIA INC,20049557,CDM,983,RC,49557,HCPCS,outpatient,,,2116.25,1058.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RPR INITIAL INCISIOL VENTRAL HERNIA,20049560,CDM,983,RC,49560,HCPCS,outpatient,,,2164.25,1082.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RPR INITIAL INCISIOL VENTRAL HERNIA,20049561,CDM,983,RC,49561,HCPCS,outpatient,,,2734.5,1367.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RPR RECURRENT INCISIOL VENTRAL HERN,20049565,CDM,983,RC,49565,HCPCS,outpatient,,,2238.75,1119.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS IMPLANTATION OF MESH PROSTHESIS OPEN,20049568,CDM,983,RC,49568,HCPCS,outpatient,,,831.75,415.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REPAIR EPIGASTRIC HERNIA INCAR/STRANG,20049572,CDM,983,RC,49572,HCPCS,outpatient,,,1364.75,682.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Repair of umbilical hernia in patients over 5 years old,20049585,CDM,983,RC,49585,HCPCS,outpatient,,,1263.25,631.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REPAIR UMBILICAL HERNIA 5YR+ INC,20049587,CDM,983,RC,49587,HCPCS,outpatient,,,1503.25,751.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REPAIR SPIGELIAN HERNIA,20049590,CDM,983,RC,49590,HCPCS,outpatient,,,1652.5,826.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Inguil hernia repair done by laparoscope,20049650,CDM,983,RC,49650,HCPCS,outpatient,,,1242,621,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPROSCOPY SURG RPR VENTRAL UMBIL HER,20049652,CDM,983,RC,49652,HCPCS,outpatient,,,2334.75,1167.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPROSCOPY SURG RPR VENTRAL UMB HERNI,20049653,CDM,983,RC,49653,HCPCS,outpatient,,,2995.75,1497.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPAROSCOP SURG RPR INCISION HERN RED,20049654,CDM,983,RC,49654,HCPCS,outpatient,,,2436,1218,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPROSCOP SURG RPR INCISION HERNIA IN,20049655,CDM,983,RC,49655,HCPCS,outpatient,,,3321,1660.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPAR SURG RPR RECURR INCIS HERNIA,20049656,CDM,983,RC,49656,HCPCS,outpatient,,,2452,1226,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPAR SURG RPR RECURR INCIS HERNIA,20049657,CDM,983,RC,49657,HCPCS,outpatient,,,4008.5,2004.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPROSCOPY INTERL HERNIA REPAIR,20049659,CDM,983,RC,49659,HCPCS,outpatient,,,3587.5,1793.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SUTURE SECONDARY ABD WALL EVISCERATIO,20049900,CDM,983,RC,49900,HCPCS,outpatient,,,2292.25,1146.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OMENTAL FLAP INTRA-ABD,20049905,CDM,983,RC,49905,HCPCS,outpatient,,,1609.75,804.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ASPIRATION/INJ REL CYST OR PELVIS,20050390,CDM,983,RC,50390,HCPCS,outpatient,,,250.5,125.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS URETEROTOMY FOR INSERTION OF INDWELL,20050605,CDM,983,RC,50605,HCPCS,outpatient,,,3464.75,1732.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CYSTOSTOMY WITH DRAIN,20051040,CDM,983,RC,51040,HCPCS,outpatient,,,1705.75,852.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INJ PROC RETROGRADE URETHROCYSTOGRAPH,20051610,CDM,983,RC,51610,HCPCS,outpatient,,,341.25,170.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ANTERIOR VESICOURETHROPEXY SIMPLE,20051840,CDM,983,RC,51840,HCPCS,outpatient,,,3550.25,1775.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ANTERIOR VESICOURETHROPEXY COMP,20051841,CDM,983,RC,51841,HCPCS,outpatient,,,4275,2137.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ABDOMINO-VAGIL VESICAL NECK SUS,20051845,CDM,983,RC,51845,HCPCS,outpatient,,,3907.25,1953.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CYSTOURETHROSCOPY W CATH,20052005,CDM,983,RC,52005,HCPCS,outpatient,,,965,482.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CYSTOURETHROSCOPY W BIOPSY,20052204,CDM,983,RC,52204,HCPCS,outpatient,,,469.25,234.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CYSTOURETHROSCOPY W FULGURATION,20052214,CDM,983,RC,52214,HCPCS,outpatient,,,2596,1298,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CYSTOURETHROSCOPY MED BLADDER TUMOR,20052235,CDM,983,RC,52235,HCPCS,outpatient,,,2020.25,1010.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CYSTOURETHROSCOPY W CALIB,20052281,CDM,983,RC,52281,HCPCS,outpatient,,,1092.75,546.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CYSTOURETHROSCOPY W MANIP,20052330,CDM,983,RC,52330,HCPCS,outpatient,,,2729.25,1364.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS MEATOTOMY,20053020,CDM,983,RC,53020,HCPCS,outpatient,,,559.75,279.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION OR FULGURATION URETHRAL CARU,20053265,CDM,983,RC,53265,HCPCS,outpatient,,,767.5,383.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DILATION OF URETHRAL STRICTURE VESICA,20053605,CDM,983,RC,53605,HCPCS,outpatient,,,309.25,154.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DILATION OF URETHRAL STRICTURE FILIFO,20053620,CDM,983,RC,53620,HCPCS,outpatient,,,432,216,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DILATION OF FEMALE URETHA INC,20053660,CDM,983,RC,53660,HCPCS,outpatient,,,138.75,69.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CIRCUMCISION CLAMP,20054150,CDM,983,RC,54150,HCPCS,outpatient,,,533.25,266.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CIRCUMCISION SURG EXCISION,20054160,CDM,983,RC,54160,HCPCS,outpatient,,,570.5,285.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CIRCUMCISION SURG EXCISION > 28 DAYS,20054161,CDM,983,RC,54161,HCPCS,outpatient,,,954.25,477.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ORCHIECTOMY SIMPLE,20054520,CDM,983,RC,54520,HCPCS,outpatient,,,1513.75,756.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ORCHIOPEXY INGUIL APPROACH,20054640,CDM,983,RC,54640,HCPCS,outpatient,,,2665.25,1332.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INCISION AND DRAIGE EPIDIDYMIS TEST,20054700,CDM,983,RC,54700,HCPCS,outpatient,,,693,346.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PUNCTURE ASPIRATION OF HYDROCELE,20055000,CDM,983,RC,55000,HCPCS,outpatient,,,282.75,141.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION HYDROCELE UNILATERAL,20055040,CDM,983,RC,55040,HCPCS,outpatient,,,1716.5,858.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REPAIR TUNICA VAGILIS HYDROCELE,20055060,CDM,983,RC,55060,HCPCS,outpatient,,,1498,749,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DRAIGE SCROTAL WALL ABSCESS,20055100,CDM,983,RC,55100,HCPCS,outpatient,,,741,370.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REMOVAL FOREIGN BODY IN SCROTUM,20055120,CDM,983,RC,55120,HCPCS,outpatient,,,965,482.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION LESION SPERMATIC CORD,20055520,CDM,983,RC,55520,HCPCS,outpatient,,,1482,741,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Biopsy of prostate gland,20055700,CDM,983,RC,55700,HCPCS,outpatient,,,453.25,226.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INCISION AND DRAIGE VULVA PERINEAL,20056405,CDM,983,RC,56405,HCPCS,outpatient,,,442.5,221.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INCISION AND DRAIGE BARTHOLIN GLAND,20056420,CDM,983,RC,56420,HCPCS,outpatient,,,437.25,218.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS MARSUPIALIZATION BARTHOLIN GLAND,20056440,CDM,983,RC,56440,HCPCS,outpatient,,,1162.25,581.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DESTRUCTION OF LESION VULVA SIMPLE,20056501,CDM,983,RC,56501,HCPCS,outpatient,,,378.75,189.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DESTRUCTION OF LESION VULVA EXTEN,20056515,CDM,983,RC,56515,HCPCS,outpatient,,,869,434.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS BIOPSY VULVA PERINEUM ONE,20056605,CDM,983,RC,56605,HCPCS,outpatient,,,352,176,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS BIOPSY VULVA PERINEUM EA,20056606,CDM,983,RC,56606,HCPCS,outpatient,,,197.25,98.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION OF BARTHOLIN'S GLAND CYST,20056740,CDM,983,RC,56740,HCPCS,outpatient,,,1343.25,671.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DESTRUCITON VAGIL LESION SIMPLE LAS,20057061,CDM,983,RC,57061,HCPCS,outpatient,,,383.75,191.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DESTRUCITON VAGIL LESION EXTEN LAS,20057065,CDM,983,RC,57065,HCPCS,outpatient,,,522.5,261.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS BIOPSY VAGIL MUCOSA SIMPLE,20057100,CDM,983,RC,57100,HCPCS,outpatient,,,320,160,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS BIOPSY VAGIL MUCOSA EXTENSIVE,20057105,CDM,983,RC,57105,HCPCS,outpatient,,,602.5,301.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION OF VAGIL CYST OR TUMOR,20057135,CDM,983,RC,57135,HCPCS,outpatient,,,470.75,235.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS FITTING INSERT PESSARY INTRAVAG DEV,20057160,CDM,983,RC,57160,HCPCS,outpatient,,,197.25,98.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS COLPORRHAPHY SUTURE INJURY VAGI PER,20057200,CDM,983,RC,57200,HCPCS,outpatient,,,1316.75,658.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ANTERIOR COLPORRHAPHY RPR,20057240,CDM,983,RC,57240,HCPCS,outpatient,,,2068.25,1034.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS POSTERIOR COLPORRHAPHY RPR RECTOCELE,20057250,CDM,983,RC,57250,HCPCS,outpatient,,,2158.75,1079.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS COMBINED ANTEROPOSTERIOR COLPORRHAPHY,20057260,CDM,983,RC,57260,HCPCS,outpatient,,,3086.25,1543.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS COMBINED ANTEROPOSTERIOR COLPORRHAPHY,20057265,CDM,983,RC,57265,HCPCS,outpatient,,,3550.25,1775.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INSERTION OF MESH PROSTHESIS FOR PELV,20057267,CDM,983,RC,57267,HCPCS,outpatient,,,1098.25,549.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"GS COLPOPEXY, VAGIL, EXTRAPERITONEAL",20057282,CDM,983,RC,57282,HCPCS,outpatient,,,1167.25,583.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS COLPOPEXY VAGIL,20057283,CDM,983,RC,57283,HCPCS,outpatient,,,3363.5,1681.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Replacement of sling to support the bladder,20057288,CDM,983,RC,57288,HCPCS,outpatient,,,3646,1823,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLOSURE RECTOVAGIL FISTULA,20057300,CDM,983,RC,57300,HCPCS,outpatient,,,2857.25,1428.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PELVIC EXAM UNDER ANES,20057410,CDM,983,RC,57410,HCPCS,outpatient,,,330.5,165.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS COLPOSCOPY CERVIX INC UPPER ADJ,20057452,CDM,983,RC,57452,HCPCS,outpatient,,,400,200,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Biopsy of cervix or uterus,20057454,CDM,983,RC,57454,HCPCS,outpatient,,,575.75,287.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS BIOPSY CERVIX SINGLE OR MULTI,20057500,CDM,983,RC,57500,HCPCS,outpatient,,,367.75,183.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ENDOCERVICAL CURETTAGE,20057505,CDM,983,RC,57505,HCPCS,outpatient,,,352,176,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CAUTERY CERVIX ELECTRO OR THERMAL,20057510,CDM,983,RC,57510,HCPCS,outpatient,,,410.5,205.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CAUTERY CERVIX CRYOCAUTERY INITIAL,20057511,CDM,983,RC,57511,HCPCS,outpatient,,,469.25,234.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CONIZATION CERVIX,20057520,CDM,983,RC,57520,HCPCS,outpatient,,,1695.25,847.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION OF CERVICAL STUMP,20057550,CDM,983,RC,57550,HCPCS,outpatient,,,1828.5,914.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DILATION CERVICAL CAL,20057800,CDM,983,RC,57800,HCPCS,outpatient,,,277.25,138.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Biopsy of the lining of the uterus,20058100,CDM,983,RC,58100,HCPCS,outpatient,,,383.75,191.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DILATION CURETTAGE,20058120,CDM,983,RC,58120,HCPCS,outpatient,,,1311.5,655.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS TOTAL ABDOMIL HYSTERECTOMY,20058150,CDM,960,RC,58150,HCPCS,outpatient,,,3038.25,1519.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS TOTAL ABDOMIL HYSTERECTOMY,20058200,CDM,983,RC,58200,HCPCS,outpatient,,,6257.75,3128.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS VAGIL HYSTERECTOMY FOR UT <250 G,20058260,CDM,983,RC,58260,HCPCS,outpatient,,,4296.5,2148.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS VAGIL HYSTERECTOMY FOR UT,20058262,CDM,983,RC,58262,HCPCS,outpatient,,,4653.5,2326.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS VAGIL HYSTERECTOMY FOR UT,20058267,CDM,983,RC,58267,HCPCS,outpatient,,,5575.75,2787.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REMOVE INTRAUTERINE DEVICE,20058301,CDM,983,RC,58301,HCPCS,outpatient,,,287.75,143.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS HYSTERRHAPHY RPR RUPTURED UTERUS,20058520,CDM,983,RC,58520,HCPCS,outpatient,,,3534.25,1767.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPAROSCOPY SUPRCERVICAL HYST W TUB O,20058542,CDM,983,RC,58542,HCPCS,outpatient,,,2926.25,1463.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPAROSCOPY SURG WITH VAG HYSTER,20058550,CDM,983,RC,58550,HCPCS,outpatient,,,2724,1362,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS HYSTEROSCOPY DIAG,20058555,CDM,983,RC,58555,HCPCS,outpatient,,,1370,685,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Surgical hysteroscopy with biopsy,20058558,CDM,983,RC,58558,HCPCS,outpatient,,,1871.25,935.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS HYSTEROSCOPY SURG WITH LYSIS,20058559,CDM,983,RC,58559,HCPCS,outpatient,,,2809,1404.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS HYSTEROSCOPY SURG WITH SEPTUM,20058560,CDM,983,RC,58560,HCPCS,outpatient,,,2873,1436.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS HYSTEROSCOPY SURG WITH LEIOMYOMATA,20058561,CDM,983,RC,58561,HCPCS,outpatient,,,3065,1532.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS HYSTEROSCOPY SURG WITH IMPACTED,20058562,CDM,983,RC,58562,HCPCS,outpatient,,,1780.25,890.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Surgical procedure used to treat premenopausal abnormal uterine bleeding,20058563,CDM,983,RC,58563,HCPCS,outpatient,,,3955,1977.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LIGATION TRANS FALLOPIAN TUBE,20058600,CDM,983,RC,58600,HCPCS,outpatient,,,2286.75,1143.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LIGATION TRANS FALLOPIAN TUBE,20058605,CDM,983,RC,58605,HCPCS,outpatient,,,1887,943.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LIGATION TRANS FALLOPIAN TUBE,20058611,CDM,983,RC,58611,HCPCS,outpatient,,,1082.25,541.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPROSCOPY SURG WITH LYSIS ADHESION,20058660,CDM,983,RC,58660,HCPCS,outpatient,,,3097,1548.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Removal of either benign or malignt tissue from the uterus, ovaries, fallopian tubes, or any of the surrounding tissues using a laparoscope",20058661,CDM,983,RC,58661,HCPCS,outpatient,,,3560.75,1780.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Removal of lesions of the ovary, pelvic viscera, or peritoneal surface",20058662,CDM,983,RC,58662,HCPCS,outpatient,,,3326,1663,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPROSCOPY SURG WITH FULGURATION,20058670,CDM,983,RC,58670,HCPCS,outpatient,,,2372,1186,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Laparoscopic tubal sterilization is surgery to block the fallopian tubes to prevent pregncy,20058671,CDM,983,RC,58671,HCPCS,outpatient,,,2276,1138,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPROSCOPY SURG WITH FIMBRIOPLASTY,20058672,CDM,983,RC,58672,HCPCS,outpatient,,,3683.5,1841.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPROSCOPY SURG WITH SALPINGOSTOMY,20058673,CDM,983,RC,58673,HCPCS,outpatient,,,3566,1783,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SALPINGECTOMY,20058700,CDM,983,RC,58700,HCPCS,outpatient,,,2958.5,1479.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SALPINGO-OOPHORECTOMY,20058720,CDM,983,RC,58720,HCPCS,outpatient,,,2196.25,1098.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LYSIS ADHESIONS,20058740,CDM,983,RC,58740,HCPCS,outpatient,,,3267.5,1633.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS TUBOUTERINE IMPLANTATION,20058752,CDM,983,RC,58752,HCPCS,outpatient,,,4680.25,2340.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DRAIGE OF OVARIAN CYST,20058800,CDM,983,RC,58800,HCPCS,outpatient,,,1087.5,543.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DRAIGE OF OVARIAN CYST ABD,20058805,CDM,983,RC,58805,HCPCS,outpatient,,,2073.5,1036.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OVARIAN CYSTECTOMY,20058925,CDM,983,RC,58925,HCPCS,outpatient,,,2238.75,1119.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OOPHORECTOMY PARTIAL OR TOTAL,20058940,CDM,983,RC,58940,HCPCS,outpatient,,,2979.75,1489.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ECTOPIC PREG,20059121,CDM,983,RC,59121,HCPCS,outpatient,,,3177,1588.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ECTOPIC PREG ABDOMIL PREG,20059130,CDM,983,RC,59130,HCPCS,outpatient,,,3118.25,1559.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPROSCOPIC TRT ECTOPIC PREGNCY,20059150,CDM,983,RC,59150,HCPCS,outpatient,,,2494.75,1247.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPROSCOPIC TRT ECTOPIC PREGNCY,20059151,CDM,983,RC,59151,HCPCS,outpatient,,,2420,1210,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CURETTAGE POSTPARTUM,20059160,CDM,983,RC,59160,HCPCS,outpatient,,,1146,573,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Cesarean delivery,20059514,CDM,983,RC,59514,HCPCS,outpatient,,,3305,1652.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SUBTOTAL OR TOTAL HYST AFTER C SECT,20059525,CDM,983,RC,59525,HCPCS,outpatient,,,2494.75,1247.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CES DEL AFTER VAG ATTEMPT PREV C SEC,20059620,CDM,983,RC,59620,HCPCS,outpatient,,,3854,1927,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS TRT INCOMPLETE ABORTION SURGICALLY,20059812,CDM,983,RC,59812,HCPCS,outpatient,,,1311.5,655.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PARTIAL THYROID LOBECTOMY UNILATERAL,20060210,CDM,983,RC,60210,HCPCS,outpatient,,,3257,1628.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION THYROGLOSSAL DUCT CYST,20060280,CDM,983,RC,60280,HCPCS,outpatient,,,2809,1404.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PARATHYROIDECTOMY OR EXPLORATION,20060500,CDM,983,RC,60500,HCPCS,outpatient,,,4461.5,2230.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SPIL PUNCTURE LUMBAR DIAG,20062270,CDM,983,RC,62270,HCPCS,outpatient,,,309.25,154.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INPLANT REPLACE DEVICE SUBQ RESERVOIR,20062360,CDM,983,RC,62360,HCPCS,outpatient,,,970.25,485.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INJECTION ANES AGENT ILIOINGUIL,20064425,CDM,983,RC,64425,HCPCS,outpatient,,,277.25,138.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS NEUROPLASTY NERVE OF HAND OR FOOT,20064704,CDM,983,RC,64704,HCPCS,outpatient,,,1620.5,810.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS NEUROPLASTY MAJ PERIPHERAL NERVE,20064708,CDM,983,RC,64708,HCPCS,outpatient,,,2846.25,1423.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS NEUROPLASTY/TRANS ULR AT WRIST,20064719,CDM,983,RC,64719,HCPCS,outpatient,,,2244.25,1122.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Release of the transverse carpal ligament,20064721,CDM,983,RC,64721,HCPCS,outpatient,,,1188.75,594.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DECOMPRESSION UNSPEC NERVE,20064722,CDM,983,RC,64722,HCPCS,outpatient,,,799.75,399.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION NEUROFIBROMA CUTAN NERVE,20064788,CDM,983,RC,64788,HCPCS,outpatient,,,1082.25,541.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SUTURE DIGITAL NERVE HAND OR FOOT 1 N,20064831,CDM,983,RC,64831,HCPCS,outpatient,,,2468,1234,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SUTURE MAJ NERVE ARM OR LEG WO TRANS,20064857,CDM,983,RC,64857,HCPCS,outpatient,,,4045.75,2022.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REMOVAL FOR BODY EXT EYE CONJ SUPER,20065205,CDM,983,RC,65205,HCPCS,outpatient,,,240,120,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REPAIR LACERATION CORNEA NONPERF,20065275,CDM,983,RC,65275,HCPCS,outpatient,,,2271,1135.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION CHALAZION GEN ANEST SING MUL,20067808,CDM,983,RC,67808,HCPCS,outpatient,,,842.25,421.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION EXT EAR PARTIAL SIMPLE RPR,20069110,CDM,983,RC,69110,HCPCS,outpatient,,,1103.5,551.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REMOVAL FOR BODY EXT AUD CAL,20069200,CDM,983,RC,69200,HCPCS,outpatient,,,112.25,56.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of ear wax from one or both ears,20069210,CDM,983,RC,69210,HCPCS,outpatient,,,106.75,53.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS TYMPANOSTOMY TUBE-BILAT,20069433,CDM,983,RC,69433,HCPCS,outpatient,,,154.5,77.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISE AURAL PULYP,20069540,CDM,983,RC,69540,HCPCS,outpatient,,,154.5,77.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS UGI W/O KUB INTERPRETATION,20074240,CDM,972,RC,74240,HCPCS,outpatient,,,138.75,69.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Ultrasound of head and neck,20076536,CDM,972,RC,76536,HCPCS,outpatient,,,112.25,56.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS US BREAST COMPLETE,20076641,CDM,972,RC,76641,HCPCS,outpatient,,,213.25,106.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Ultrasound of abdomen with all areas scanned,20076700,CDM,972,RC,76700,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
A diagnostic procedure that allows a provider to see the organs and other structures in the abdomen,20076705,CDM,972,RC,76705,HCPCS,outpatient,,,85.5,42.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Ultrasound of back wall of the abdomen with all areas viewed,20076770,CDM,972,RC,76770,HCPCS,outpatient,,,144,72,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Ultrasound of back wall of the abdomen with limited areas viewed,20076775,CDM,972,RC,76775,HCPCS,outpatient,,,117.25,58.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Diagnostic ultrasound of an extremity excluding the bone, joints or vessels",20076882,CDM,972,RC,76882,HCPCS,outpatient,,,112.25,56.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS US GUIDE FOR NEEDLE PLACEMENT,20076942,CDM,972,RC,76942,HCPCS,outpatient,,,133.5,66.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS US GUIDANCE INTRAOPERATIVE,20076998,CDM,972,RC,76998,HCPCS,outpatient,,,218.75,109.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CPR,20092950,CDM,982,RC,92950,HCPCS,outpatient,,,853,426.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Study of vessels on both sides of the head and neck,20093880,CDM,972,RC,93880,HCPCS,outpatient,,,156.75,78.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries,20093922,CDM,972,RC,93922,HCPCS,outpatient,,,33.25,16.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS US ABI MULTI LEVEL,20093923,CDM,972,RC,93923,HCPCS,outpatient,,,58.5,29.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS US DUPLEX SCAN LOW EXTR ART COMP BIL,20093925,CDM,972,RC,93925,HCPCS,outpatient,,,130,65,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DUPLEX SCAN/US LOW EXTRM RT OR LIMITE,20093926,CDM,972,RC,93926,HCPCS,outpatient,,,77.25,38.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DUPLEX SCAN UPPER EXTRM ART UNILAT LI,20093931,CDM,983,RC,93931,HCPCS,outpatient,,,75.5,37.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Complete bilateral study of the extremities,20093970,CDM,983,RC,93970,HCPCS,outpatient,,,90.75,45.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
One sided or limited bilateral study,20093971,CDM,983,RC,93971,HCPCS,outpatient,,,58.75,29.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS US DUP SCAN AORTA INF VE CAVA COMPL,20093978,CDM,972,RC,93978,HCPCS,outpatient,,,125,62.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Debridement (for example, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps)",20097597,CDM,983,RC,97597,HCPCS,outpatient,,,128,64,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DEBRIDMT EPT/DERMIS EA ADDTL 20 SQCM,20097598,CDM,983,RC,97598,HCPCS,outpatient,,,181.25,90.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REMOVAL OF DEVITALIZED TISSUE,20097602,CDM,983,RC,97602,HCPCS,outpatient,,,85.5,42.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS WOUND VAC 50  SQCM OR LESS,20097605,CDM,983,RC,97605,HCPCS,outpatient,,,80,40,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS WOUND VAC OVER 50 SQCM,20097606,CDM,983,RC,97606,HCPCS,outpatient,,,90.75,45.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS GLOBAL,20099024,CDM,969,RC,99024,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 10 minutes",20099202,CDM,983,RC,99202,HCPCS,outpatient,,,106.75,53.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 30 min",20099203,CDM,983,RC,99203,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 45 min",20099204,CDM,983,RC,99204,HCPCS,outpatient,,,266.75,133.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 60 min",20099205,CDM,983,RC,99205,HCPCS,outpatient,,,341.25,170.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient not requiring a physician,20099211,CDM,983,RC,99211,HCPCS,outpatient,,,26.75,13.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient requiring a physician,20099212,CDM,983,RC,99212,HCPCS,outpatient,,,58.75,29.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",20099213,CDM,983,RC,99213,HCPCS,outpatient,,,106.75,53.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 25 minutes",20099214,CDM,983,RC,99214,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient, visit typically 40 minutes",20099215,CDM,983,RC,99215,HCPCS,outpatient,,,229.25,114.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OBSERVATION DISCHARGE,20099217,CDM,983,RC,99217,HCPCS,outpatient,,,170.75,85.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OBSERVATION CARE INITIAL LOW,20099218,CDM,983,RC,99218,HCPCS,outpatient,,,165.5,82.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OBSERVATION CARE INITIAL MODERATE,20099219,CDM,983,RC,99219,HCPCS,outpatient,,,272,136,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OBSERVATION CARE INITIAL HIGH,20099220,CDM,983,RC,99220,HCPCS,outpatient,,,378.75,189.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INITIAL HOSPITAL CARE LOW,20099221,CDM,987,RC,99221,HCPCS,outpatient,,,234.5,117.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INITIAL HOSPITAL CARE MODERATE,20099222,CDM,987,RC,99222,HCPCS,outpatient,,,320,160,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INITIAL HOSPITAL CARE HIGH,20099223,CDM,987,RC,99223,HCPCS,outpatient,,,463.75,231.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SUBSEQUENT OBSERV CARE PROB FOC,20099224,CDM,982,RC,99224,HCPCS,outpatient,,,80,40,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SUB OV CARE MOD COMP,20099225,CDM,982,RC,99225,HCPCS,outpatient,,,138.75,69.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SUBSEQ OBS HIGH COMPLEXITY,20099226,CDM,987,RC,99226,HCPCS,outpatient,,,202.75,101.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SUBSEQUENT HOSPITAL CARE LOW,20099231,CDM,987,RC,99231,HCPCS,outpatient,,,101.25,50.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SUBSEQUENT HOSPITAL CARE MODERATE,20099232,CDM,987,RC,99232,HCPCS,outpatient,,,176,88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SUBSEQUENT HOSPITAL CARE HIGH,20099233,CDM,987,RC,99233,HCPCS,outpatient,,,250.5,125.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OBS IP ADMIT DISC SAME DAY LOW,20099234,CDM,987,RC,99234,HCPCS,outpatient,,,330.5,165.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OBS IP ADMIT DISC SAME DAY MODERATE,20099235,CDM,987,RC,99235,HCPCS,outpatient,,,432,216,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OBS IP ADMIT DISC SAME DAY HIGH,20099236,CDM,987,RC,99236,HCPCS,outpatient,,,543.75,271.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS HOSPITAL DISCHARGE DAY MGMT < 30 MIN,20099238,CDM,987,RC,99238,HCPCS,outpatient,,,170.75,85.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS HOSPITAL DISCHARGE DAY MGMT > 30 MIN,20099239,CDM,987,RC,99239,HCPCS,outpatient,,,250.5,125.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ER SCREEN MINIMAL,20099281,CDM,981,RC,99281,HCPCS,outpatient,,,53.5,26.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EMERGENCY DEPT VISIT LOW,20099282,CDM,981,RC,99282,HCPCS,outpatient,,,106.75,53.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, moderately severe problem",20099283,CDM,981,RC,99283,HCPCS,outpatient,,,165.5,82.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem of high severity",20099284,CDM,981,RC,99284,HCPCS,outpatient,,,309.25,154.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem with significant threat to life or function",20099285,CDM,981,RC,99285,HCPCS,outpatient,,,458.75,229.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INIT NURSING FACILITY CARE/DAY LOW,20099304,CDM,983,RC,99304,HCPCS,outpatient,,,208,104,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SUBSEQUENT NRSG FAC PROB FOCUSED,20099307,CDM,983,RC,99307,HCPCS,outpatient,,,106.75,53.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SUBS NURS FAC LOW,20099308,CDM,983,RC,99308,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS COMMUNITY VEIN SCREENING,20099990,CDM,983,RC,,,outpatient,,,69.5,34.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DAY CHARGE,20099991,CDM,983,RC,,,outpatient,,,2601.25,1300.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS HALF DAY CHARGE,20099992,CDM,983,RC,,,outpatient,,,1300.5,650.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SCREENING FLEX SIGMOIDOSCOPY,20099994,CDM,983,RC,G0104,HCPCS,outpatient,,,128,64,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SUTURE REMOVAL,20099997,CDM,969,RC,99024,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,20099998,CDM,983,RC,G0121,HCPCS,outpatient,,,1375.5,687.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Colorectal cancer screening; colonoscopy on individual at high risk,20099999,CDM,983,RC,G0105,HCPCS,outpatient,,,1375.5,687.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 11-20 minutes of medical discussion",20508442,CDM,983,RC,99442,HCPCS,outpatient,,,106.75,53.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Incision and draige of abscess; simple or single and complex or multiple,20510060,CDM,983,RC,10060,HCPCS,outpatient,,,240,120,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS INC DRAIN ABSCESS MULTIPLE,20510061,CDM,983,RC,10061,HCPCS,outpatient,,,432,216,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS INC REMOVE FOR BODY COMPLICATED,20510121,CDM,983,RC,10121,HCPCS,outpatient,,,485.25,242.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Incision and draige of hematoma, seroma or fluid collection",20510140,CDM,983,RC,10140,HCPCS,outpatient,,,309.25,154.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Puncture aspiration of abscess, hematoma, bulla, or cyst",20510160,CDM,983,RC,10160,HCPCS,outpatient,,,247.5,123.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS INC DRAIN COMPLEX POSTOP WOUND INF,20510180,CDM,983,RC,10180,HCPCS,outpatient,,,458.75,229.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS DEBRIDEMENT OPEN FX DISL SKIN SUBC,20511010,CDM,983,RC,11010,HCPCS,outpatient,,,754.75,377.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS DEBRIDEMENT/REMOVAL FB OPEN FX MUSCLE,20511011,CDM,983,RC,11011,HCPCS,outpatient,,,703.25,351.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS DEBRIDEMENT SKIN SUBCUT TISSUE,20511042,CDM,983,RC,11042,HCPCS,outpatient,,,133.5,66.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS DEBRIDEMENT BONE 20 SQCM OR LESS,20511044,CDM,983,RC,11044,HCPCS,outpatient,,,823.25,411.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Removal of skin tags, multiple fibrocutaneous tags, any area",20511200,CDM,983,RC,11200,HCPCS,outpatient,,,170.75,85.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS EXC LES BEN .6-1.0 CM SCALP NECK HAND,20511421,CDM,983,RC,11421,HCPCS,outpatient,,,277.25,138.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Under Excision-Benign Lesions Procedures on the Skin 1.1-2 CM,20511422,CDM,983,RC,11422,HCPCS,outpatient,,,334,167,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Separation and removal of the entire il plate or a portion of il plate,20511730,CDM,983,RC,11730,HCPCS,outpatient,,,168.5,84.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS REPAIR IL BED,20511760,CDM,983,RC,11760,HCPCS,outpatient,,,331.75,165.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS RECONSTRUCTION IL BED W GRAFT,20511762,CDM,983,RC,11762,HCPCS,outpatient,,,521.25,260.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Simple repair of superficial wounds of scalp, neck, axillae, exterl genitalia, trunk and/or extremities",20512001,CDM,983,RC,12001,HCPCS,outpatient,,,197.25,98.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS SIMP RPR SUPERFICIAL WD 2.6-7.5 CM,20512002,CDM,983,RC,12002,HCPCS,outpatient,,,218.75,109.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS LAYER CLOSE WOUNDS < 2.5 CM EXTRM TRK,20512031,CDM,983,RC,12031,HCPCS,outpatient,,,400,200,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS REPAIR COMPLEX SCALP 2.6 TO 7.5 CM,20513121,CDM,983,RC,13121,HCPCS,outpatient,,,810.25,405.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS REPAIR COMPLEX SCALP EA ADD 5CM LESS,20513122,CDM,983,RC,13122,HCPCS,outpatient,,,234.5,117.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS REPAIR COMPLEX FOREHEAD 2.6 TO 7.5 CM,20513132,CDM,983,RC,13132,HCPCS,outpatient,,,1167.25,583.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS FULL THICKNESS GRAFT FREE < 20 SQ CM,20515240,CDM,983,RC,15240,HCPCS,outpatient,,,1988.25,994.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS EXPLORATION PENETRATING WOUND EXTREM,20520103,CDM,983,RC,20103,HCPCS,outpatient,,,939.75,469.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS BIOPSY BONE OPEN SUPERFICIAL,20520240,CDM,983,RC,20240,HCPCS,outpatient,,,598,299,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS REMOVAL FB MUSCLE/TENDON SH DEEP/COMP,20520525,CDM,983,RC,20525,HCPCS,outpatient,,,675,337.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CARPAL TUNNEL INJECTION,20520526,CDM,983,RC,20526,HCPCS,outpatient,,,162.25,81.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Injection of medication into a tendon or ligament,20520550,CDM,983,RC,20550,HCPCS,outpatient,,,86.75,43.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS TRIGGER POINT INJ 1-2 MUSCLES,20520552,CDM,983,RC,20552,HCPCS,outpatient,,,102.75,51.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Injection of medication into an area that triggers pain,20520553,CDM,983,RC,20553,HCPCS,outpatient,,,112.75,56.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a small joint/bursa without ultrasound,20520600,CDM,983,RC,20600,HCPCS,outpatient,,,85.5,42.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ASPIRATION INJECT SM JT/BURSA W/GUIDE,20520604,CDM,983,RC,20604,HCPCS,outpatient,,,119.75,59.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a large joint/bursa without ultrasound,20520605,CDM,983,RC,20605,HCPCS,outpatient,,,92.75,46.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a major joint/bursa without ultrasound,20520610,CDM,983,RC,20610,HCPCS,outpatient,,,112.75,56.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHROCENT ASP/INJ MAJ JT/BUR W/GUID,20520611,CDM,983,RC,20611,HCPCS,outpatient,,,156.75,78.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS REMOVAL OF IMPLANT DEEP,20520680,CDM,983,RC,20680,HCPCS,outpatient,,,1066,533,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS APPLICATION UNIPLANE EXT FIX SYST UNI,20520690,CDM,983,RC,20690,HCPCS,outpatient,,,1391.5,695.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS REMOVAL EXTERL FIX SYSTEM UNDER ANE,20520694,CDM,983,RC,20694,HCPCS,outpatient,,,930.75,465.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHROTOMY GLENOHUMERAL JT W/EXPLORAT,20523107,CDM,983,RC,23107,HCPCS,outpatient,,,1738.25,869.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS RPR RUPTURED ROTATOR CUFF OPEN ACUTE,20523410,CDM,983,RC,23410,HCPCS,outpatient,,,2369.25,1184.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS REPAIR ROTATOR CUFF OPEN CHRONIC,20523412,CDM,983,RC,23412,HCPCS,outpatient,,,2407.5,1203.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHROPLASTY GLENOHUMERAL JT HEMIARTH,20523470,CDM,983,RC,23470,HCPCS,outpatient,,,3296.75,1648.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS SHOULDER ARTHROPLASTY TOTAL/REVERSE,20523472,CDM,983,RC,23472,HCPCS,outpatient,,,3665.75,1832.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX CLAVICULAR FX W/O MANIP,20523500,CDM,983,RC,23500,HCPCS,outpatient,,,501,250.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OPEN TX CLAVICULAR FX ORIF,20523515,CDM,983,RC,23515,HCPCS,outpatient,,,1806.5,903.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLSD TX ACROMIOCLAVICULAR DISL WO MAN,20523540,CDM,983,RC,23540,HCPCS,outpatient,,,574.25,287.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OPEN TX ACROMIOCLAVIC DISLOC W/GRAFT,20523552,CDM,983,RC,23552,HCPCS,outpatient,,,1629.5,814.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX SCAPULAR FX W/O MANIP,20523570,CDM,983,RC,23570,HCPCS,outpatient,,,586.5,293.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OPEN TX SCAPULAR FX W/FIXATION,20523585,CDM,983,RC,23585,HCPCS,outpatient,,,2446.5,1223.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX PROXIMAL HUMERUS FX W/O MAN,20523600,CDM,983,RC,23600,HCPCS,outpatient,,,703,351.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OPEN TX PROXIMAL HUMERAL FX,20523615,CDM,983,RC,23615,HCPCS,outpatient,,,2537.5,1268.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX GREATER HUMERAL TUBER W/O M,20523620,CDM,983,RC,23620,HCPCS,outpatient,,,630.75,315.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHROPLASTY INTERPHALANG JT,20523655,CDM,983,RC,26535,HCPCS,outpatient,,,964.75,482.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX SHOULDER DISLOC W/FX HUM TU,20523665,CDM,983,RC,23665,HCPCS,outpatient,,,1037,518.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS MANIPULATION UNDER ANES SHOULDER JT,20523700,CDM,983,RC,23700,HCPCS,outpatient,,,575.75,287.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS INC DRAIN ELBOW BURSA,20523931,CDM,983,RC,23931,HCPCS,outpatient,,,400,200,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS EXCISION TUMOR SOFT TIS UP ARM <5 CM,20524076,CDM,983,RC,24076,HCPCS,outpatient,,,1220.25,610.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS EXCISION OLECRANON BURSA,20524105,CDM,983,RC,24105,HCPCS,outpatient,,,949,474.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS REMOVAL FB UPPER ARM/ELBOW DEEP,20524201,CDM,983,RC,24201,HCPCS,outpatient,,,983.25,491.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS REINSERT RUPTURED BICEP TENDON DISTAL,20524342,CDM,983,RC,24342,HCPCS,outpatient,,,2086,1043,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS REPAIR LAT COL LIGAMENT ELBOW LOC TIS,20524343,CDM,983,RC,24343,HCPCS,outpatient,,,1766,883,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS TENOTOMY ELBOW LAT/MED SOFT TIS/BONE,20524358,CDM,983,RC,24358,HCPCS,outpatient,,,1312,656,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS TENOTOMY ELBOW LATERAL/MEDIAL RPR,20524359,CDM,983,RC,24359,HCPCS,outpatient,,,1651,825.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX HUMERAL SHAFT FX W/O MANIP,20524500,CDM,983,RC,24500,HCPCS,outpatient,,,750.25,375.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS TX HUMERAL SHAFT FX INTRAMEDULLARY IM,20524516,CDM,983,RC,24516,HCPCS,outpatient,,,2285.25,1142.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CL TX SUPRACONCDYLAR TRANS HUM FX W/O,20524530,CDM,983,RC,24530,HCPCS,outpatient,,,821,410.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CL TX HUMERAL EPICONDYLAR FX W/O MANI,20524560,CDM,983,RC,24560,HCPCS,outpatient,,,666.5,333.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX HUMERAL CONDYLAR FX,20524576,CDM,983,RC,24576,HCPCS,outpatient,,,709,354.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OPEN TX DISTAL HUMERUS/ELBOW,20524586,CDM,983,RC,24586,HCPCS,outpatient,,,2716.25,1358.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS TRT ELBOW DISLOCATION W/O ANESTHESIA,20524600,CDM,983,RC,24600,HCPCS,outpatient,,,1045,522.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX RADIUS HEAD/NECK FX W/O MAN,20524650,CDM,983,RC,24650,HCPCS,outpatient,,,541.25,270.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX ULR FX PROX END W/O MANIP,20524670,CDM,983,RC,24670,HCPCS,outpatient,,,609,304.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OPEN TX ULR FX PROX END ORIF,20524685,CDM,983,RC,24685,HCPCS,outpatient,,,1704,852,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS INCISION EXTENSOR TENDON SHEATH WRIST,20525000,CDM,983,RC,25000,HCPCS,outpatient,,,855.75,427.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS EXCISION TUMOR FOREARM WRIST 3CM >,20525073,CDM,983,RC,25073,HCPCS,outpatient,,,1512.5,756.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS EXC TUMOR SOFT TISSUE FORARM DEEP,20525076,CDM,983,RC,25076,HCPCS,outpatient,,,1258.25,629.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS EXC TENDON FOREARM WRIST FLEX/EXTENSO,20525109,CDM,983,RC,25109,HCPCS,outpatient,,,1339,669.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS EXC GANGLION WRIST PRIM,20525111,CDM,983,RC,25111,HCPCS,outpatient,,,885,442.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS RADICAL TENOSYNOVECTOMY WRIST EXTENSO,20525116,CDM,983,RC,25116,HCPCS,outpatient,,,1653.75,826.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS EXCISION BONE CYST/TUMOR CARPAL BONES,20525130,CDM,983,RC,25130,HCPCS,outpatient,,,1078.75,539.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CARPECTOMY 1 BONE,20525210,CDM,983,RC,25210,HCPCS,outpatient,,,1335.75,667.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CARPECTOMY ALL BONES PROXIMAL ROW,20525215,CDM,983,RC,25215,HCPCS,outpatient,,,1680.25,840.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS RADIAL STYLOIDECTOMY,20525230,CDM,983,RC,25230,HCPCS,outpatient,,,1114.75,557.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS TENDON TRANSFER/TRANSPLANT FLEX/EXT F,20525310,CDM,983,RC,25310,HCPCS,outpatient,,,1725.25,862.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CAPSULORRHAPHY WRIST OPEN,20525320,CDM,983,RC,25320,HCPCS,outpatient,,,2621.75,1310.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHROPLASTY WRIST W W/O INTERPOS W W,20525332,CDM,983,RC,25332,HCPCS,outpatient,,,2208,1104,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OSTEOPLASTY RADIUS OR UL SHORTENING,20525390,CDM,983,RC,25390,HCPCS,outpatient,,,2172.25,1086.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS RPR NONUNION SCAPHOID ORIF W/BONE GRA,20525440,CDM,983,RC,25440,HCPCS,outpatient,,,2173.5,1086.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHROPLASTY W/PROSTHETIC REPL LUTE,20525444,CDM,983,RC,25444,HCPCS,outpatient,,,2144.5,1072.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHROPLASTY CARPOMETACARPAL JTS,20525447,CDM,983,RC,25447,HCPCS,outpatient,,,2128.5,1064.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX RADIAL SHAFT FX W/ MANIP,20525505,CDM,983,RC,25505,HCPCS,outpatient,,,1219,609.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX ULR SHAFT FX W/O MANIP,20525530,CDM,983,RC,25530,HCPCS,outpatient,,,538.5,269.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ORIF ULR SHAFT FX,20525545,CDM,983,RC,26010,HCPCS,outpatient,,,587,293.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX RADIAL/ULR SHAFT FX W/MAN,20525565,CDM,983,RC,25565,HCPCS,outpatient,,,1184.25,592.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CL TX DISTAL RADIAL FX W/W/O UL W/M,20525600,CDM,983,RC,25600,HCPCS,outpatient,,,618.5,309.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX DISTAL RADIAL FX W MAINIPUL,20525605,CDM,983,RC,25605,HCPCS,outpatient,,,1427.75,713.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS PERCUTANEOUS SKELET FIX DIST RADIAL F,20525606,CDM,983,RC,25606,HCPCS,outpatient,,,1696.5,848.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OPEN TRT DISTAL RADIAL FX W/INT FIXAT,20525607,CDM,983,RC,25607,HCPCS,outpatient,,,1956,978,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ORIF DISTAL RADIUS INTRA ARTIC FX 2 F,20525608,CDM,983,RC,25608,HCPCS,outpatient,,,2261.5,1130.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ORIF DISTAL RADIAL INTRA-ART FX EPY S,20525609,CDM,983,RC,25609,HCPCS,outpatient,,,2811,1405.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CL TX CARPAL SCAPHOID FX WO MANIPULAT,20525622,CDM,983,RC,25622,HCPCS,outpatient,,,996.75,498.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CARPAL BONE -EACH BONE,20525630,CDM,983,RC,25630,HCPCS,outpatient,,,652,326,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS PERCUTANEOUS SKELET FIX ULR STYL FX,20525651,CDM,983,RC,25651,HCPCS,outpatient,,,1198.25,599.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OPEN TX ULR STYLOID FX,20525652,CDM,983,RC,25652,HCPCS,outpatient,,,1691,845.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHRODESIS WRIST COMPLETE WO BONE GR,20525800,CDM,983,RC,25800,HCPCS,outpatient,,,1763,881.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHRODESIS WRIST W/AUTOGRAFT,20525825,CDM,983,RC,25825,HCPCS,outpatient,,,1925,962.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHRODESIS DIST RADIOULR JT BONE G,20525830,CDM,983,RC,25830,HCPCS,outpatient,,,2390.75,1195.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS DRAIGE FINGER ABSCESS SIMPLE,20526010,CDM,983,RC,26010,HCPCS,outpatient,,,587,293.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS DRAIN FINGER ABSCESS COMPLICATED,20526011,CDM,983,RC,26011,HCPCS,outpatient,,,1045,522.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS DRAIGE TENDON SHEATH DIGIT/PALM EAC,20526020,CDM,983,RC,26020,HCPCS,outpatient,,,1062,531,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS RELEASE TENDON SHEATH,20526055,CDM,983,RC,26055,HCPCS,outpatient,,,1606.25,803.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHROTOMY IP JOINT,20526080,CDM,983,RC,26080,HCPCS,outpatient,,,900.75,450.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS EXCISION TUMOR OR VASCULAR MALFORM,20526111,CDM,983,RC,26111,HCPCS,outpatient,,,1204.75,602.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS EXC TUM SOFT TIS HAND/FING SUBFAS 1.5,20526113,CDM,983,RC,26113,HCPCS,outpatient,,,1451.75,725.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS EXC SOFT TIS TUMOR HAND/FINGER <1.5CM,20526116,CDM,983,RC,26116,HCPCS,outpatient,,,1245.25,622.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS FASCIECTOMY PART PLAMAR REL SING DIGI,20526123,CDM,983,RC,26123,HCPCS,outpatient,,,2220,1110,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS SYNOVECTOMY TENDON SHEATH FLEX TENDON,20526145,CDM,983,RC,26145,HCPCS,outpatient,,,1384.5,692.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS EXCISION LES TENDON SHEATH HAND/FINGE,20526160,CDM,983,RC,26160,HCPCS,outpatient,,,817.75,408.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS PARTIAL EXC BONE DISTAL PHALANX FINGE,20526236,CDM,983,RC,26236,HCPCS,outpatient,,,1118.25,559.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS REPAIR FLEXOR TENDON PRIMARY EACH,20526356,CDM,983,RC,26356,HCPCS,outpatient,,,2553.25,1276.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS REPAIR EXT TENDON FINGER EACH,20526418,CDM,983,RC,26418,HCPCS,outpatient,,,1451.25,725.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS TENOLYSIS EXT TENDON HAND/FINGER EA T,20526445,CDM,983,RC,26445,HCPCS,outpatient,,,1431,715.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CAPSULECTOMY/CAPSULOTOMY IP JOINT EAC,20526525,CDM,983,RC,26525,HCPCS,outpatient,,,1586.5,793.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHROPLASTY MCP JT W/IMPLANT EACH,20526531,CDM,983,RC,26531,HCPCS,outpatient,,,1596,798,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHROPLASTY INTERPHALANG JT,20526535,CDM,983,RC,26535,HCPCS,outpatient,,,1058.5,529.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS RPR COLLATERAL LIGAMENT MCP/IP JT,20526540,CDM,983,RC,26540,HCPCS,outpatient,,,1632.5,816.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS RPR/RECONSTRUCT FINGER VOLAR PLATE IP,20526548,CDM,983,RC,26548,HCPCS,outpatient,,,1906.5,953.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX METACARPAL W/O MANIP EACH B,20526600,CDM,983,RC,26600,HCPCS,outpatient,,,634,317,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED FX METACARPAL FX SINGL W MANIP,20526605,CDM,983,RC,26605,HCPCS,outpatient,,,738.25,369.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS PERC SKELETAL FIX METACARPAL FX EACH,20526608,CDM,983,RC,26608,HCPCS,outpatient,,,1184.25,592.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OPEN TX METACARPAL FX ORIF EACH BONE,20526615,CDM,983,RC,26615,HCPCS,outpatient,,,1370.5,685.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CARPOMETACARPAL FX DISL PERC SKEL FIX,20526650,CDM,983,RC,26650,HCPCS,outpatient,,,1185.5,592.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS PERC SKELETAL FIX CARPOMETACARP EACH,20526676,CDM,983,RC,26676,HCPCS,outpatient,,,1289.25,644.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX PHALANX SHAFT FX FINGER W/O,20526720,CDM,983,RC,26720,HCPCS,outpatient,,,408.25,204.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CL TX PHALANX SHAFT FX W/ MANIP,20526725,CDM,983,RC,26725,HCPCS,outpatient,,,764,382,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS PHALANX FX PROX/MID FING/THUMB W/MANI,20526727,CDM,983,RC,26727,HCPCS,outpatient,,,1173.75,586.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OPEN TX PHALANX SHAFT FX FINGER EACH,20526735,CDM,983,RC,26735,HCPCS,outpatient,,,1436,718,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CL TRT FX MCP IP JOINT W/O MANIP EACH,20526740,CDM,983,RC,26740,HCPCS,outpatient,,,524.25,262.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OPEN TX ARTICULAR FX MP IP EACH JT,20526746,CDM,983,RC,26746,HCPCS,outpatient,,,2254.75,1127.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX DISTAL PHALANX FX W/O MANIP,20526750,CDM,983,RC,26750,HCPCS,outpatient,,,406,203,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ORIF DISTAL PHALANGEAL FX FINGER THUM,20526765,CDM,983,RC,26765,HCPCS,outpatient,,,1154,577,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLSD TX INTERPHALANGEAL JT DISLOCATIO,20526770,CDM,983,RC,26770,HCPCS,outpatient,,,711.5,355.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OPEN TRT INTERPHALANGEAL JT DISLOC,20526785,CDM,983,RC,26785,HCPCS,outpatient,,,1492.5,746.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHRODESIS INTERPHALNG JT,20526860,CDM,983,RC,26860,HCPCS,outpatient,,,1399,699.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHRODESIS IP JT W/W/O FIXATION ADDT,20526861,CDM,983,RC,26861,HCPCS,outpatient,,,303.75,151.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS AMPUTATION FINGER THUMB SINGLE W/DIRE,20526951,CDM,983,RC,26951,HCPCS,outpatient,,,1490,745,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS AMPUTATION FINGER ANY JT SINGLE ADV F,20526952,CDM,983,RC,26952,HCPCS,outpatient,,,1583.5,791.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS REMOVAL FB PELVIS HIP DEEP,20527087,CDM,983,RC,27087,HCPCS,outpatient,,,1766,883,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS REMOVAL HIP PROSTHESIS,20527090,CDM,983,RC,27090,HCPCS,outpatient,,,2006,1003,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHROPLASTY TOTAL HIP,20527130,CDM,983,RC,27130,HCPCS,outpatient,,,4160.5,2080.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS REVISION TOTAL HIP ARTHROPL BOTH COMP,20527134,CDM,983,RC,27134,HCPCS,outpatient,,,4836.75,2418.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CL TX POST PELVIC RING FX AND/OR SACR,20527197,CDM,983,RC,27197,HCPCS,outpatient,,,234,117,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CL TX ACETABULUM FX W/O MANIP,20527220,CDM,983,RC,27220,HCPCS,outpatient,,,1387,693.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLSD TX FEMORAL FX PROX END WO MANIP,20527230,CDM,983,RC,27230,HCPCS,outpatient,,,1567,783.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS PERCUTANEOUS SKELETAL FIX FEMUR FX NE,20527235,CDM,983,RC,27235,HCPCS,outpatient,,,2191.5,1095.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OPEN RED TRT FEMORAL FX ORIF,20527236,CDM,983,RC,27236,HCPCS,outpatient,,,3165,1582.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS TRT TROCHANETERIC FEM FX W/IMPLANT SC,20527244,CDM,983,RC,27244,HCPCS,outpatient,,,5277,2638.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS TX INTERTROCHANGERIC FEM FX W MED IMP,20527245,CDM,983,RC,27245,HCPCS,outpatient,,,3662.5,1831.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX POST HIP ARTHOPLASTY DISLOC,20527266,CDM,983,RC,27266,HCPCS,outpatient,,,1566,783,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS I&D DEEP ABSCESS BURSA HEMAT THIGH/KN,20527301,CDM,983,RC,27301,HCPCS,outpatient,,,1372,686,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS SUTURE INFRAPATELLAR TENDON PRIMARY,20527380,CDM,983,RC,27380,HCPCS,outpatient,,,1464.75,732.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS SUTURE QUADRICEP/HAMSTRING RUPT PRIMA,20527385,CDM,983,RC,27385,HCPCS,outpatient,,,1468.5,734.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHROTOMY MENISCUS RPR KNEE,20527403,CDM,983,RC,27403,HCPCS,outpatient,,,1791,895.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHROPLASTY TOTAL KNEE,20527447,CDM,983,RC,27447,HCPCS,outpatient,,,4217.75,2108.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX SUPRACOND FEMORAL FX W/O MA,20527501,CDM,983,RC,27501,HCPCS,outpatient,,,1315.5,657.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLSD TX SUPRACONDYLAR FEMORAL FX,20527503,CDM,983,RC,27503,HCPCS,outpatient,,,3086.25,1543.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OPEN TX FEMORAL SHAFT FX W/ IM IMPLAN,20527506,CDM,983,RC,27506,HCPCS,outpatient,,,5772.75,2886.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX FEMORAL FX WO MANIP,20527508,CDM,983,RC,27508,HCPCS,outpatient,,,1236.75,618.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OPEN TX FEMORAL SUPRACONDYLAR ORIF,20527511,CDM,983,RC,27511,HCPCS,outpatient,,,2833,1416.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OPEN TX FEMUR FX DIST END CONDYLE ORI,20527514,CDM,983,RC,27514,HCPCS,outpatient,,,2819.75,1409.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX PATELLAR FX W/O MANIP,20527520,CDM,983,RC,27520,HCPCS,outpatient,,,732.5,366.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OPEN TX PATELLAR FX ORIF PATELLECTOMY,20527524,CDM,983,RC,27524,HCPCS,outpatient,,,1879.25,939.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX TIBIAL FX W/O MANIP,20527530,CDM,983,RC,27530,HCPCS,outpatient,,,889.75,444.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX TIBIAL FX PROXIM W W/O MANI,20527532,CDM,983,RC,27532,HCPCS,outpatient,,,1438.25,719.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ORIF TIBIAL FX UNICONDYLAR,20527535,CDM,983,RC,27535,HCPCS,outpatient,,,3907.25,1953.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS RPR RUPTURED ACHILLES TENDON PRIMARY,20527652,CDM,983,RC,27652,HCPCS,outpatient,,,2113.25,1056.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS RPR ACHILLES TENDON SECOND W/W/O GRAF,20527654,CDM,983,RC,27654,HCPCS,outpatient,,,1934.25,967.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS RPR EXTENS TENDON LEG W/O GRAFT EACH,20527664,CDM,983,RC,27664,HCPCS,outpatient,,,931.25,465.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS RPR PRIMARY DISRUPTED LIGAMENT ANKLE,20527695,CDM,983,RC,27695,HCPCS,outpatient,,,1181.25,590.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS REPAIR TIBIA NONUNION/MALUNION ORIF,20527720,CDM,983,RC,27720,HCPCS,outpatient,,,2112.25,1056.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS REPAIR FIBULA NONUNION MALUNION ORIF,20527726,CDM,983,RC,27726,HCPCS,outpatient,,,2311,1155.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX TIBIAL SHAFT FX W/O MANIP,20527750,CDM,983,RC,27750,HCPCS,outpatient,,,752.25,376.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX TIBIAL SHAFT FX W/ MANIP,20527752,CDM,983,RC,27752,HCPCS,outpatient,,,1348.5,674.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OPEN TX TIBIAL SHAFT FX W PLATE/SCREW,20527758,CDM,983,RC,27758,HCPCS,outpatient,,,2514,1257,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ORIF TIB/FIB SHAFT INTRAMED IMPLANT,20527759,CDM,983,RC,27759,HCPCS,outpatient,,,2860.25,1430.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLSD TX MEDIAL MALLEOLUS FX WO MANIP,20527760,CDM,983,RC,27760,HCPCS,outpatient,,,764.5,382.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OPEN TX MED MALLEOLUS FX ORIF IF PERF,20527766,CDM,983,RC,27766,HCPCS,outpatient,,,1505.75,752.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX POSTERIOR MALLEOLUS FX W/O,20527767,CDM,983,RC,27767,HCPCS,outpatient,,,637.75,318.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OPEN TX POSTERIOR MALLEOLUS FX ORIF,20527769,CDM,983,RC,27769,HCPCS,outpatient,,,1820.5,910.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX PROX FIBULA  FX W/O MANIP,20527780,CDM,983,RC,27780,HCPCS,outpatient,,,634,317,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX DIST FIBULAR FX W/O MANIP,20527786,CDM,983,RC,27786,HCPCS,outpatient,,,671.25,335.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLD TX FX DISTAL FIBULA W/MANIP,20527788,CDM,983,RC,27788,HCPCS,outpatient,,,960,480,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ORIF DISTAL FIBULA,20527792,CDM,983,RC,27792,HCPCS,outpatient,,,1936.75,968.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX BIMALLEOLAR FX,20527808,CDM,983,RC,27808,HCPCS,outpatient,,,724.25,362.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CL TX BIMALLEOLAR ANKLE FX W/MANIP,20527810,CDM,983,RC,27810,HCPCS,outpatient,,,1124.5,562.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OPEN  TX BIMALLEOLAR ANKLE FX ORIF,20527814,CDM,983,RC,27814,HCPCS,outpatient,,,2130,1065,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSE TX TRIMALLEOLAR ANKLE FX W MANI,20527818,CDM,983,RC,27818,HCPCS,outpatient,,,2004.5,1002.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OPEN TX TRIMALLEOLAR ANKLE FX ORIF ME,20527822,CDM,983,RC,27822,HCPCS,outpatient,,,2224.5,1112.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX FX DISTAL TIBIA W/O MANIP,20527824,CDM,983,RC,27824,HCPCS,outpatient,,,742.25,371.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLD TX FX DIST TIBIA MANIP OR SKEL TR,20527825,CDM,983,RC,27825,HCPCS,outpatient,,,1232.5,616.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OPEN TX FX ART SURFACE DISTAL TIB W/F,20527827,CDM,983,RC,27827,HCPCS,outpatient,,,2771.5,1385.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OPEN TX DISTAL TIB FIB JT DISRUPTION,20527829,CDM,983,RC,27829,HCPCS,outpatient,,,1783.25,891.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TREATMENT ANKLE DISLOCATION,20527840,CDM,983,RC,27840,HCPCS,outpatient,,,1018.25,509.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHROTOMY MTP JOINT,20528022,CDM,983,RC,28022,HCPCS,outpatient,,,782,391,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS FASCIECTOMY PLANTAR FASCIA RADICAL,20528062,CDM,983,RC,28062,HCPCS,outpatient,,,1160.75,580.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS EXCISION LESION TENDON/SHEATH FOOT,20528090,CDM,983,RC,28090,HCPCS,outpatient,,,870.5,435.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS HEMIPHALANGECTOMY/IP JT EXC PROX PHAL,20528160,CDM,983,RC,28160,HCPCS,outpatient,,,665,332.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS REPAIR TENDON FLEX FOOT W/O GRAFT EAC,20528200,CDM,983,RC,28200,HCPCS,outpatient,,,874.25,437.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS REPAIR TENDON FOOT EXTENSOR EACH,20528208,CDM,983,RC,28208,HCPCS,outpatient,,,889,444.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX CALCANEAL FX W/O MANIP,20528400,CDM,983,RC,28400,HCPCS,outpatient,,,539.25,269.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLSD TX TALUS FX W/O MANIP,20528430,CDM,983,RC,28430,HCPCS,outpatient,,,491.75,245.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS TX TARSAL BONE FX WO MANIP EACH,20528450,CDM,983,RC,28450,HCPCS,outpatient,,,455.75,227.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLD TX METATARSAL FX W/O MANIIP EACH,20528470,CDM,983,RC,28470,HCPCS,outpatient,,,460.75,230.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS PERC SKELETAL FIX METATARSAL FX W MAN,20528476,CDM,983,RC,28476,HCPCS,outpatient,,,839,419.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OPEN TX METATARSAL FX ORIF EACH,20528485,CDM,983,RC,28485,HCPCS,outpatient,,,1374,687,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX FX GREAT TOE PHALANX W/O MA,20528490,CDM,983,RC,28490,HCPCS,outpatient,,,282.5,141.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS PERCUTANEOUS SKELET FIX GRT TOE W/MAN,20528496,CDM,983,RC,28496,HCPCS,outpatient,,,1236.75,618.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLD TX FX PHALANX TOE W/O MANIP EACH,20528510,CDM,983,RC,28510,HCPCS,outpatient,,,275.25,137.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OPEN TRT FX  PHALANX PHALANGES,20528525,CDM,983,RC,28525,HCPCS,outpatient,,,1343.25,671.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS CLOSED TX INTERPHALANGEAL JT DISLOCAT,20528660,CDM,983,RC,28660,HCPCS,outpatient,,,222.25,111.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS AMPUTATION FOOT TRANSMETATARSAL,20528805,CDM,983,RC,28805,HCPCS,outpatient,,,1743,871.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS AMPUTATION TOE METATARSOPHALANGEAL JT,20528820,CDM,983,RC,28820,HCPCS,outpatient,,,1401.25,700.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS AMPUTATION TOE INTERPHALANGEAL JT,20528825,CDM,983,RC,28825,HCPCS,outpatient,,,1045.75,522.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS APPLICATION LONG ARM CAST,20529105,CDM,983,RC,29105,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS APPLICATION SHORT ARM SPLINT,20529125,CDM,983,RC,29125,HCPCS,outpatient,,,109,54.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHROSCOPY SHOULDER CAPSULORRHAPHY,20529806,CDM,983,RC,29806,HCPCS,outpatient,,,2930.75,1465.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHROSCOPY SHOULDER RPR SLAP LESION,20529807,CDM,983,RC,29807,HCPCS,outpatient,,,2851.5,1425.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS SHOULDER ARTHROSCOPY DEBRIDE LIMITED,20529822,CDM,983,RC,29822,HCPCS,outpatient,,,1511,755.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHROSCOPY SHOULDER DEBRIDEMENT EXTE,20529823,CDM,983,RC,29823,HCPCS,outpatient,,,1756,878,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHROSCOPY SHOULDER DIST CLAV EXCISI,20529824,CDM,983,RC,29824,HCPCS,outpatient,,,1519,759.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Shaving of shoulder bone using an endoscope,20529826,CDM,983,RC,29826,HCPCS,outpatient,,,1417.75,708.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHROSCOPY SHOULDER ROTATOR CUFF,20529827,CDM,983,RC,29827,HCPCS,outpatient,,,2899.75,1449.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHROSCOPY SHOULDER BICEPS TENODESIS,20529828,CDM,983,RC,29828,HCPCS,outpatient,,,2315.75,1157.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS KNEE ARTHROSCOPY OSTEOCHONDRAL ALLOGR,20529867,CDM,983,RC,29867,HCPCS,outpatient,,,3373.5,1686.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHROSCOPY KNEE LAVAGE & DRAIN,20529871,CDM,983,RC,29871,HCPCS,outpatient,,,1422.75,711.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHROSCOPY KNEE W/LATERAL RELEASE,20529873,CDM,983,RC,29873,HCPCS,outpatient,,,1323,661.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHROSCOPY KNEE REMOVAL FB/LOOSE BOD,20529874,CDM,983,RC,29874,HCPCS,outpatient,,,1445.25,722.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHROSCOPY KNEE SYNOVECTOMY LIMITED,20529875,CDM,983,RC,29875,HCPCS,outpatient,,,1375.5,687.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHROSCOPY KNEE SYNOVECTOMY 2>,20529876,CDM,983,RC,29876,HCPCS,outpatient,,,1809,904.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ARTHROSCOPY KNEE CHONDROPLASTY,20529877,CDM,983,RC,29877,HCPCS,outpatient,,,1708.25,854.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Surgery to remove of all or part of a torn meniscus in both medial and lateral compartments,20529880,CDM,983,RC,29880,HCPCS,outpatient,,,1554,777,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Surgery to remove of all or part of a torn meniscus in one compartment,20529881,CDM,983,RC,29881,HCPCS,outpatient,,,1491.75,745.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ACL reconstruction,20529888,CDM,983,RC,29888,HCPCS,outpatient,,,2834.25,1417.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS LIGATION MAJOR ARTERY EXTREMITY,20537618,CDM,983,RC,37618,HCPCS,outpatient,,,1871.25,935.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a small joint/bursa without ultrasound,20550600,CDM,983,RC,20600,HCPCS,outpatient,,,171,85.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Release of the transverse carpal ligament,20560721,CDM,983,RC,64721,HCPCS,outpatient,,,1187.75,593.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS NEUROPLAST TRANSPOSIT ULR NERVE ELB,20564718,CDM,983,RC,64718,HCPCS,outpatient,,,1398,699,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS NEUROPLASTY TRANS ULR AT WRIST,20564719,CDM,983,RC,64719,HCPCS,outpatient,,,2244.25,1122.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Release of the transverse carpal ligament,20564721,CDM,983,RC,64721,HCPCS,outpatient,,,1187.75,593.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Release of the transverse carpal ligament,20584721,CDM,983,RC,64721,HCPCS,outpatient,,,1187.75,593.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS LAPROSCOPY SURGICAL APPENDECTOMY ASSI,20594970,CDM,983,RC,44970,HCPCS,outpatient,,,286,143,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS GLOBAL,20599024,CDM,969,RC,99024,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 10 minutes",20599202,CDM,983,RC,99202,HCPCS,outpatient,,,107,53.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 30 min",20599203,CDM,983,RC,99203,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 45 min",20599204,CDM,983,RC,99204,HCPCS,outpatient,,,265,132.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 60 min",20599205,CDM,983,RC,99205,HCPCS,outpatient,,,343.5,171.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient not requiring a physician,20599211,CDM,983,RC,99211,HCPCS,outpatient,,,24.5,12.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient requiring a physician,20599212,CDM,983,RC,99212,HCPCS,outpatient,,,56.5,28.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",20599213,CDM,983,RC,99213,HCPCS,outpatient,,,106.25,53.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 25 minutes",20599214,CDM,983,RC,99214,HCPCS,outpatient,,,162,81,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient, visit typically 40 minutes",20599215,CDM,983,RC,99215,HCPCS,outpatient,,,228.75,114.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OBSERVATION CARE INITIAL LOW,20599218,CDM,983,RC,99218,HCPCS,outpatient,,,165.25,82.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OBSERVATION CARE INITIAL MODERATE,20599219,CDM,983,RC,99219,HCPCS,outpatient,,,270.75,135.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS INITIAL HOSPITAL CARE LOW,20599221,CDM,987,RC,99221,HCPCS,outpatient,,,234.25,117.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS INITIAL HOSPITAL CARE MODERATE,20599222,CDM,987,RC,99222,HCPCS,outpatient,,,318.5,159.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS INITIAL HOSPITAL CARE HIGH,20599223,CDM,987,RC,99223,HCPCS,outpatient,,,465.25,232.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS SUBSEQUENT OBSERV CARE PROB FOC,20599224,CDM,987,RC,99224,HCPCS,outpatient,,,78.75,39.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS SUB OV CARE MOD COMP,20599225,CDM,987,RC,99225,HCPCS,outpatient,,,137,68.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS SUBSEQ OBS HIGH COMPLEXITY,20599226,CDM,987,RC,99226,HCPCS,outpatient,,,203,101.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS SUBSEQUENT HOSPITAL CARE LOW,20599231,CDM,987,RC,99231,HCPCS,outpatient,,,99,49.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS SUBSEQUENT HOSPITAL CARE MODERATE,20599232,CDM,987,RC,99232,HCPCS,outpatient,,,174.75,87.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS SUBSEQUENT HOSPITAL CARE HIGH,20599233,CDM,987,RC,99233,HCPCS,outpatient,,,248.25,124.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS OBS IP ADMIT DISC SAME DAY LOW,20599234,CDM,987,RC,99234,HCPCS,outpatient,,,329.75,164.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS HOSPITAL DISCHARGE DAY MGMT < 30 MIN,20599238,CDM,987,RC,99238,HCPCS,outpatient,,,172.25,86.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS HOSPITAL DISCHARGE DAY MGMT > 30 MIN,20599239,CDM,987,RC,99239,HCPCS,outpatient,,,248.75,124.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ER SCREEN MINIMAL,20599281,CDM,981,RC,99281,HCPCS,outpatient,,,54.5,27.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS ER PT LOW,20599282,CDM,981,RC,99282,HCPCS,outpatient,,,106.5,53.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, moderately severe problem",20599283,CDM,981,RC,99283,HCPCS,outpatient,,,164.75,82.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem of high severity",20599284,CDM,981,RC,99284,HCPCS,outpatient,,,307.75,153.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem with significant threat to life or function",20599285,CDM,981,RC,99285,HCPCS,outpatient,,,458.25,229.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS INIT NURSING FACILITY CARE/DAY LOW,20599304,CDM,983,RC,99304,HCPCS,outpatient,,,208,104,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS INIT NURSING FACILITY CARE/DAY MOD,20599305,CDM,983,RC,99305,HCPCS,outpatient,,,289.25,144.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS NURS FAC INIT/ANNUAL HIGH COMPLEX,20599306,CDM,983,RC,99306,HCPCS,outpatient,,,378.25,189.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS SUBSEQUENT NRSG FAC PROB FOCUSED,20599307,CDM,983,RC,99307,HCPCS,outpatient,,,105,52.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS SUBS NURS FAC LOW,20599308,CDM,983,RC,99308,HCPCS,outpatient,,,157.5,78.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS SUBS NRSING FACILITY CARE PER DAY MOD,20599309,CDM,983,RC,99309,HCPCS,outpatient,,,208.25,104.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS NURS FAC SUB CARE HIGH COMPLEX,20599310,CDM,983,RC,99310,HCPCS,outpatient,,,310.5,155.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS NURSING FACILITY CARE DISCHARGE DAY,20599315,CDM,983,RC,99315,HCPCS,outpatient,,,152.75,76.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS NURS FAC DISCHARGE < 30 MIN,20599316,CDM,983,RC,99316,HCPCS,outpatient,,,199,99.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 HBPC REVIEW RESULTS,20700006,CDM,969,RC,99024,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 REVIEW RESULTS,20700024,CDM,969,RC,99024,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 TRIM TOE ILS,20700127,CDM,983,RC,G0127,HCPCS,outpatient,,,29,14.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 COUNSELING LUNG CANCER SCREEN LDCT,20700296,CDM,983,RC,G0296,HCPCS,outpatient,,,49.75,24.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 REMOVAL SUTURES PHYSICIAN OTHER THAN,20700630,CDM,983,RC,S0630,HCPCS,outpatient,,,43.5,21.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS NEEDLE CORE BREAST BX WO IMAG LEFT,20701100,CDM,983,RC,19100,HCPCS,outpatient,,,388,194,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 TH MEDICAL DISCUSSION 5-10 MIN,20702012,CDM,982,RC,G2012,HCPCS,outpatient,,,33.5,16.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ADJUST GASTRIC BAND DIAMETER VIA SUBC,20702083,CDM,983,RC,S2083,HCPCS,outpatient,,,139.25,69.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAP SURG RPR PARAESOPHAG HERNIA  ASST,20703281,CDM,983,RC,43281,HCPCS,outpatient,,,794.5,397.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS US PUNCT ASPIR CYST BREAST LT,20708031,CDM,972,RC,19000,HCPCS,outpatient,,,148.25,74.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 5-10 minutes of medical discussion",20708441,CDM,983,RC,99441,HCPCS,outpatient,,,58.75,29.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 11-20 minutes of medical discussion",20708442,CDM,983,RC,99442,HCPCS,outpatient,,,106.75,53.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 21-30 minutes of medical discussion",20708443,CDM,983,RC,99443,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 10 minutes",20708902,CDM,983,RC,99202,HCPCS,outpatient,,,107,53.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 30 min",20708903,CDM,983,RC,99203,HCPCS,outpatient,,,161.75,80.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 45 min",20708904,CDM,983,RC,99204,HCPCS,outpatient,,,268.75,134.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 60 min",20708905,CDM,983,RC,99205,HCPCS,outpatient,,,349.5,174.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient not requiring a physician,20708911,CDM,983,RC,99211,HCPCS,outpatient,,,24.5,12.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient requiring a physician,20708912,CDM,983,RC,99212,HCPCS,outpatient,,,56.5,28.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",20708913,CDM,983,RC,99213,HCPCS,outpatient,,,106.25,53.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 25 minutes",20708914,CDM,983,RC,99214,HCPCS,outpatient,,,163.25,81.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient, visit typically 40 minutes",20708915,CDM,983,RC,99215,HCPCS,outpatient,,,231.75,115.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 GLOBAL FOR OTHER PROVIDER,20709024,CDM,969,RC,99024,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ER SCREEN MINIMAL,20709281,CDM,981,RC,99281,HCPCS,outpatient,,,53.5,26.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ER PAT /LOW,20709282,CDM,981,RC,99282,HCPCS,outpatient,,,104.5,52.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, moderately severe problem",20709283,CDM,981,RC,99283,HCPCS,outpatient,,,166,83,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem of high severity",20709284,CDM,981,RC,99284,HCPCS,outpatient,,,307.75,153.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem with significant threat to life or function",20709285,CDM,981,RC,99285,HCPCS,outpatient,,,458.25,229.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INIT NURSING FACILITY CARE PER DAY MO,20709305,CDM,983,RC,99305,HCPCS,outpatient,,,289.25,144.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Fine Needle Aspiration Biopsy without imaging,20710021,CDM,983,RC,10021,HCPCS,outpatient,,,192.25,96.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Incision and draige of abscess; simple or single and complex or multiple,20710060,CDM,983,RC,10060,HCPCS,outpatient,,,239.25,119.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 INC DRAIN ABSCESS MULTIPLE,20710061,CDM,983,RC,10061,HCPCS,outpatient,,,430,215,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 INC DRAIN PILONIDAL CYST SIMPLE,20710080,CDM,983,RC,10080,HCPCS,outpatient,,,175.5,87.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 INC DRAIN PILONIDAL CYST COMPLICATED,20710081,CDM,983,RC,10081,HCPCS,outpatient,,,624.5,312.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 INC REMOVE FOR BODY SIMPLE,20710120,CDM,983,RC,10120,HCPCS,outpatient,,,236.25,118.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Incision and draige of hematoma, seroma or fluid collection",20710140,CDM,983,RC,10140,HCPCS,outpatient,,,309,154.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Puncture aspiration of abscess, hematoma, bulla, or cyst",20710160,CDM,983,RC,10160,HCPCS,outpatient,,,247.5,123.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INC DRAIN COMPLEX POSTOP WOUND INF,20710180,CDM,983,RC,10180,HCPCS,outpatient,,,458.75,229.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of infected skin,20711000,CDM,983,RC,11000,HCPCS,outpatient,,,93.75,46.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 DEBRIDE NECROTIZING SOFT TIS INF PERI,20711004,CDM,983,RC,11004,HCPCS,outpatient,,,1594.25,797.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXPLOR POSTOP HEMOR THROMB/INFECT ABD,20711008,CDM,983,RC,11008,HCPCS,outpatient,,,822.75,411.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DEBRID REM FOR MAT WFX DIS SUBCUT,20711010,CDM,983,RC,11010,HCPCS,outpatient,,,762.5,381.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DEBRID REM FOR MAT WFX DIS MUSCLE,20711011,CDM,983,RC,11011,HCPCS,outpatient,,,829,414.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DEBRIDEMENT OPEN FX SUBQ MUSCLE & BON,20711012,CDM,983,RC,11012,HCPCS,outpatient,,,1201.5,600.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 DEBRIDEMENT SKIN SUBCUT TISSUE,20711042,CDM,983,RC,11042,HCPCS,outpatient,,,135.25,67.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"S1 DEBRIDEMENT SKIN, SUBCU MUSCLE",20711043,CDM,983,RC,11043,HCPCS,outpatient,,,600.25,300.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 DEBRIDE SUBQ BONE,20711044,CDM,983,RC,11044,HCPCS,outpatient,,,823.25,411.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 DEBRIDMT SUBQ E/ADDTL 20 SQCM,20711045,CDM,983,RC,11045,HCPCS,outpatient,,,45.25,22.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 DEBRIDMT MUSCLES E/ADDTL 20 SQCM,20711046,CDM,983,RC,11046,HCPCS,outpatient,,,90,45,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 DEBRIDMT BONE E/ADDTL 20 SQCM,20711047,CDM,983,RC,11047,HCPCS,outpatient,,,153.75,76.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 PARING CUTTING BEN HYPERKERATOTIC LES,20711055,CDM,983,RC,11055,HCPCS,outpatient,,,69.5,34.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Paring or cutting of benign hyperkeratotic lesion,20711056,CDM,983,RC,11056,HCPCS,outpatient,,,94.75,47.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Tangential biopsy of skin (e.g., for example, shave, scoop, saucerize, curette); single lesion",20711102,CDM,983,RC,11102,HCPCS,outpatient,,,96,48,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 PUNCH BX SKIN SINGLE LESION,20711104,CDM,983,RC,11104,HCPCS,outpatient,,,118.25,59.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 PUNCH BX SKIN EACH ADDTL LESION,20711105,CDM,983,RC,11105,HCPCS,outpatient,,,62.75,31.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Removal of skin tags, multiple fibrocutaneous tags, any area",20711200,CDM,983,RC,11200,HCPCS,outpatient,,,169.75,84.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 REMOVAL SKIN TAGS EA ADDTL 10 OR PART,20711201,CDM,983,RC,11201,HCPCS,outpatient,,,48.75,24.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SHAVE EPID DERMAL LES SINGLE .6 TO 1,20711301,CDM,983,RC,11301,HCPCS,outpatient,,,135.25,67.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 SHAVE EPID DERMAL LES SINGLE <.5 CM,20711305,CDM,983,RC,11305,HCPCS,outpatient,,,105.25,52.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 SHAVING EPIDERMAL/DERMAL LESION .6-1.,20711306,CDM,983,RC,11306,HCPCS,outpatient,,,154.25,77.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SHAVING EPIDERMAL/DERM LES 1.1-2.0CM,20711307,CDM,983,RC,11307,HCPCS,outpatient,,,179.75,89.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 SHAVING EPIDER DERMAL LESION SCALP NE,20711308,CDM,983,RC,11308,HCPCS,outpatient,,,222.5,111.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION BEN .5 CM OR LESS,20711400,CDM,983,RC,11400,HCPCS,outpatient,,,187,93.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Under Excision-Benign Lesions Procedures on the Skin 0.6-1 CM,20711401,CDM,983,RC,11401,HCPCS,outpatient,,,250.5,125.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION BEN 1.1 TO 2.0 CM,20711402,CDM,983,RC,11402,HCPCS,outpatient,,,278.75,139.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION BEN 2.1 TO 3.0 CM,20711403,CDM,983,RC,11403,HCPCS,outpatient,,,354.75,177.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
EXCISION BEN 3.1 TO 4.0 CM,20711404,CDM,983,RC,11404,HCPCS,outpatient,,,395.75,197.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION BEN > 4.0 CM,20711406,CDM,983,RC,11406,HCPCS,outpatient,,,596.75,298.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION BEN <.5 CM,20711420,CDM,983,RC,11420,HCPCS,outpatient,,,205,102.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION BEN .6 TO 1.0 CM,20711421,CDM,983,RC,11421,HCPCS,outpatient,,,278,139,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Under Excision-Benign Lesions Procedures on the Skin 1.1-2 CM,20711422,CDM,983,RC,11422,HCPCS,outpatient,,,334,167,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION BEN 2.1 TO 3.0 CM,20711423,CDM,983,RC,11423,HCPCS,outpatient,,,391.25,195.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION BEN LESION <.5 CM,20711440,CDM,983,RC,11440,HCPCS,outpatient,,,240,120,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION BEN LESION .6 TO 1.0 CM,20711441,CDM,983,RC,11441,HCPCS,outpatient,,,318.75,159.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION BEN LESION 1.1 TO 2.0 CM,20711442,CDM,983,RC,11442,HCPCS,outpatient,,,356.75,178.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION BEN LESION 2.1 TO 3.0 CM,20711443,CDM,983,RC,11443,HCPCS,outpatient,,,445.25,222.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION BEN LESION > 4.0 CM FACE EAR,20711446,CDM,983,RC,11446,HCPCS,outpatient,,,859.25,429.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION MALIG .6 TO 1.0 CM,20711601,CDM,983,RC,11601,HCPCS,outpatient,,,365.5,182.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Excision-Malignt Lesions,20711602,CDM,983,RC,11602,HCPCS,outpatient,,,400.5,200.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
EXC MALIGNT 2.1 TO 3.0,20711603,CDM,983,RC,11603,HCPCS,outpatient,,,478.5,239.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION MALIG.6 TO 1.0 CM,20711621,CDM,983,RC,11621,HCPCS,outpatient,,,368.25,184.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION MALIG 1.1 TO 2.0 CM,20711622,CDM,983,RC,11622,HCPCS,outpatient,,,424.75,212.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"GS EXC MALIG LES SCALP, NECK, HANDS FEET",20711624,CDM,983,RC,11624,HCPCS,outpatient,,,604.25,302.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 EXCISION MALG LES <=0.5 CM LESS FACE,20711640,CDM,983,RC,11640,HCPCS,outpatient,,,304,152,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION MALIG .6 TO 1.0 CM,20711641,CDM,983,RC,11641,HCPCS,outpatient,,,395.75,197.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION MALIG 1.1 TO 2.0 CM,20711642,CDM,983,RC,11642,HCPCS,outpatient,,,467.5,233.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 TRIMMING NONDYSTROPHIC ILS ANY NUMB,20711719,CDM,983,RC,11719,HCPCS,outpatient,,,25.75,12.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 DEBRIDEMENT IL 1-5,20711720,CDM,983,RC,11720,HCPCS,outpatient,,,51.5,25.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Separation and removal of the entire il plate or a portion of il plate,20711730,CDM,983,RC,11730,HCPCS,outpatient,,,168.5,84.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION IL & MATRIX PART OR COMP,20711750,CDM,983,RC,11750,HCPCS,outpatient,,,451.5,225.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 EXCISION PILONIDAL CYST/SINUS SIMPLE,20711770,CDM,983,RC,11770,HCPCS,outpatient,,,93.75,46.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Simple repair of superficial wounds of scalp, neck, axillae, exterl genitalia, trunk and/or extremities",20712001,CDM,983,RC,12001,HCPCS,outpatient,,,196.5,98.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS TX SUPERFICIAL WOUND DEHISCENCE W/PAC,20712021,CDM,983,RC,12021,HCPCS,outpatient,,,370.5,185.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAYER CLOSE WOUNDS < 2.5 CM,20712031,CDM,983,RC,12031,HCPCS,outpatient,,,400.5,200.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAYER CLOSE WOUNDS 2.6 TO 7.5 CM,20712032,CDM,983,RC,12032,HCPCS,outpatient,,,485.25,242.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAYER CLOSE WOUNDS 12.6 TO 20.0 CM,20712035,CDM,983,RC,12035,HCPCS,outpatient,,,615.75,307.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAYER CLOSE WOUNDS 2.6 TO 7.5 CM,20712042,CDM,983,RC,12042,HCPCS,outpatient,,,356.5,178.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAYER CLOSE WOUNDS >2.5 CM,20712051,CDM,983,RC,12051,HCPCS,outpatient,,,458.75,229.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAYER CLOSE WOUNDS 2.6 TO 5.0 CM,20712052,CDM,983,RC,12052,HCPCS,outpatient,,,531,265.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
REPAIR COMPLEX SCALP 2.6 TO 7.5 CM,20713121,CDM,983,RC,13121,HCPCS,outpatient,,,811.25,405.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REPAIR COMPLEX FOREHEAD 2.6 TO 7.5 CM,20713132,CDM,983,RC,13132,HCPCS,outpatient,,,1166.75,583.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SURGICAL PREP/CREAT RECIP SITE BY EXC,20715004,CDM,983,RC,15004,HCPCS,outpatient,,,752.25,376.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS FULL THICKNESS GRAFT FREE < 20 SQ CM,20715240,CDM,983,RC,15240,HCPCS,outpatient,,,1986,993,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 APPLICATION SKIN SUB GRAFT TRUNK/ARM/,20715271,CDM,983,RC,15271,HCPCS,outpatient,,,280,140,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 APPLICATION SKIN SUB GRAFT ADDTL 25 S,20715272,CDM,983,RC,15272,HCPCS,outpatient,,,52.75,26.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 APPLICATION SKIN SUB GRAFT FIRST 25 S,20715275,CDM,983,RC,15275,HCPCS,outpatient,,,327.25,163.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DRESS AND OR  DEBRIDE < 5%,20716020,CDM,983,RC,16020,HCPCS,outpatient,,,108.25,54.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DRESS AND OR  DEBRIDE MED 5 TO 10%,20716025,CDM,983,RC,16025,HCPCS,outpatient,,,307.75,153.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of pre-cancerous lesion,20717000,CDM,983,RC,17000,HCPCS,outpatient,,,136,68,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of 2-14 pre-cancerous lesions,20717003,CDM,983,RC,17003,HCPCS,outpatient,,,16.25,8.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of 1-14 common or plantar warts,20717110,CDM,983,RC,17110,HCPCS,outpatient,,,167.75,83.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of >15 common or plantar warts,20717111,CDM,983,RC,17111,HCPCS,outpatient,,,209.5,104.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Chemical destruction of pre-cancerous lesions of the skin,20717250,CDM,983,RC,17250,HCPCS,outpatient,,,98.75,49.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS US CYST ASP BREAST RT,20719000,CDM,983,RC,19000,HCPCS,outpatient,,,267.25,133.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PUNCTURE ASPIR CYST BREAST EA ADD,20719001,CDM,983,RC,19001,HCPCS,outpatient,,,67,33.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS NEEDLE CORE BREAST BX WO IMAG BIL,20719100,CDM,983,RC,19100,HCPCS,outpatient,,,771.75,385.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
REMOVAL OF BREAST LESION,20719120,CDM,983,RC,19120,HCPCS,outpatient,,,1023.75,511.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 BIOPSY BONE OPEN SUPERFICIAL,20720240,CDM,983,RC,20240,HCPCS,outpatient,,,598,299,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CARPAL TUNNEL INJECTION,20720526,CDM,983,RC,20526,HCPCS,outpatient,,,162.25,81.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS TRIGGER PT INJ MUS,20720552,CDM,983,RC,20552,HCPCS,outpatient,,,102.75,51.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a large joint/bursa without ultrasound,20720605,CDM,983,RC,20605,HCPCS,outpatient,,,92.75,46.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a major joint/bursa without ultrasound,20720610,CDM,983,RC,20610,HCPCS,outpatient,,,112.75,56.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS BX SOFT TISSUE NECK OR THORAX,20721550,CDM,983,RC,21550,HCPCS,outpatient,,,403.5,201.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXC TUMOR SOFT TISSUE 5CM >,20721554,CDM,983,RC,21554,HCPCS,outpatient,,,2008,1004,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXC TUMOR SOFT TISS NECK/ANT THORAX S,20721556,CDM,983,RC,21556,HCPCS,outpatient,,,1118,559,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REMOVAL FB UPPER ARM/ELBOW DEEP,20724201,CDM,983,RC,24201,HCPCS,outpatient,,,983.25,491.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INC DRAIN FORARM WRIST DEEP ABSCESS,20725028,CDM,983,RC,25028,HCPCS,outpatient,,,1431,715.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXC GANGLION WRIST PRIM,20725111,CDM,983,RC,25111,HCPCS,outpatient,,,884.25,442.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DRAIGE FINGER ABSC,20726010,CDM,983,RC,26010,HCPCS,outpatient,,,587,293.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT PHALANGEAL SHAFT FX W MANI,20726725,CDM,983,RC,26725,HCPCS,outpatient,,,929.75,464.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT INTERPHALANGEAL JT DISLOCATI,20726770,CDM,983,RC,26770,HCPCS,outpatient,,,711.5,355.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 I&D DEEP ABSCESS BURSA HEMAT THIGH/KN,20727301,CDM,983,RC,27301,HCPCS,outpatient,,,1372,686,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
EXCISION TUMOR SOFT TIS THIGH KNEE>5CM,20727328,CDM,983,RC,27328,HCPCS,outpatient,,,1186.25,593.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 ARTHROPLASTY TOTAL KNEE ASSISTANT,20727447,CDM,983,RC,27447,HCPCS,outpatient,,,843.75,421.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLSD TRT PATELLAR DISLOC WO ANES,20727560,CDM,983,RC,27560,HCPCS,outpatient,,,881.25,440.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RPR FLEXOR TENDON LEG PRIMARY,20727658,CDM,983,RC,27658,HCPCS,outpatient,,,1993.5,996.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS AMPUTATION TOE INTERPHALANGEAL JT,20728825,CDM,983,RC,28825,HCPCS,outpatient,,,1303.5,651.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 APPLICATION SHORT ARM SPLINT STATIC,20729125,CDM,983,RC,29125,HCPCS,outpatient,,,109,54.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 APPLICATION RIGID TCC LEG CAST,20729445,CDM,983,RC,29445,HCPCS,outpatient,,,325.75,162.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 STRAPPING UN BOOT APPLICATION/SUPPL,20729580,CDM,983,RC,29580,HCPCS,outpatient,,,171.25,85.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 TUBE THORACOSTOMY LT,20732551,CDM,983,RC,32551,HCPCS,outpatient,,,592.25,296.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS THORACENTESIS NEEDLECATH ASP PLE W/O,20732554,CDM,983,RC,32554,HCPCS,outpatient,,,305.75,152.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG REPAIR BLOOD VESSEL LOWER EXTREM DIRE,20735226,CDM,983,RC,35226,HCPCS,outpatient,,,2548.5,1274.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXPLORE POSTOP HEMM ABDOMEN,20735840,CDM,983,RC,35840,HCPCS,outpatient,,,2015.25,1007.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS VENIPUNCTURE 3 YR OR > SKILL OF MD,20736410,CDM,983,RC,36410,HCPCS,outpatient,,,43.75,21.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INSERTION NON-TUNNELED VENOUS CATH,20736556,CDM,983,RC,36556,HCPCS,outpatient,,,685,342.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DRAIGE LYMPHY NODE ABSCES,20738300,CDM,983,RC,38300,HCPCS,outpatient,,,667,333.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"GS BIOPSY TONGUE, ANT 2/3",20741100,CDM,983,RC,41100,HCPCS,outpatient,,,421,210.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"GS BIOPSY TONGUE, POST 1/3",20741105,CDM,983,RC,41105,HCPCS,outpatient,,,409,204.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Diagnostic examition of esophagus, stomach, and/or upper small bowel using an endoscope",20743235,CDM,983,RC,43235,HCPCS,outpatient,,,595.25,297.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",20743239,CDM,983,RC,43239,HCPCS,outpatient,,,692.75,346.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS UPPER GASTROINTESTIL ENDOSCOPY,20743246,CDM,983,RC,43246,HCPCS,outpatient,,,558.5,279.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ESOPHAGOSCOPY FLEX TRAN DIAG R FB,20743247,CDM,983,RC,43247,HCPCS,outpatient,,,446.75,223.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UPPER GASTROINTESTIL ENDOSCOPY,20743251,CDM,983,RC,43251,HCPCS,outpatient,,,484,242,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS UPPER GASTROINTESTIL ENDOSCOPY,20743255,CDM,983,RC,43255,HCPCS,outpatient,,,629.75,314.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ENTERECTOMY RESECTION OF SMALL INTEST,20744120,CDM,983,RC,44120,HCPCS,outpatient,,,3576.25,1788.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS COLECTOMY PARTIAL W ASTOMOSIS,20744140,CDM,983,RC,44140,HCPCS,outpatient,,,3966,1983,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS COLECTOMY PARTIAL W ASTOMOSIS,20744143,CDM,983,RC,44143,HCPCS,outpatient,,,4858.5,2429.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INTESTIL STRICTUROPLASTY,20744615,CDM,983,RC,44615,HCPCS,outpatient,,,3172.75,1586.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLOSURE OF ENTERONETERIC OR ENTEROCOL,20744650,CDM,983,RC,44650,HCPCS,outpatient,,,3783.5,1891.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS APPENDECTOMY,20744950,CDM,983,RC,44950,HCPCS,outpatient,,,1891.5,945.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPROSCOPY SURGICAL APPENDECTOMY,20744970,CDM,983,RC,44970,HCPCS,outpatient,,,1727.5,863.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PROCTOSIGMOIDOSCOPY RIGID DIAG,20745300,CDM,983,RC,45300,HCPCS,outpatient,,,287.75,143.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SIGMOIDOSCOPY FLEXIBLE DIAG INC SPECI,20745330,CDM,983,RC,45330,HCPCS,outpatient,,,138,69,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Diagnostic examition of large bowel using an endoscope,20745378,CDM,983,RC,45378,HCPCS,outpatient,,,795,397.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of foreign bodies in large bowel using an endoscope,20745379,CDM,983,RC,45379,HCPCS,outpatient,,,1005,502.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Biopsy of large bowel using an endoscope,20745380,CDM,983,RC,45380,HCPCS,outpatient,,,1205.75,602.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Injections of large bowel using an endoscope,20745381,CDM,983,RC,45381,HCPCS,outpatient,,,708.5,354.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of polyps or growths of large bowel using an endoscope,20745385,CDM,983,RC,45385,HCPCS,outpatient,,,1080,540,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of large bowel growths using an endoscope,20745388,CDM,983,RC,45388,HCPCS,outpatient,,,921.75,460.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS COLONOSCOPY FLEX W/DECOMPRESSION,20745393,CDM,983,RC,45393,HCPCS,outpatient,,,551.5,275.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Tying of large bowel using an endoscope,20745398,CDM,983,RC,45398,HCPCS,outpatient,,,1205.75,602.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ELECTROCAUTERY/SUTURE RECTAL ULCER,20745999,CDM,983,RC,45999,HCPCS,outpatient,,,1826.5,913.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INC & DRAIN ISCHIORECTAL,20746040,CDM,983,RC,46040,HCPCS,outpatient,,,1187.75,593.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INC & DRAIN PERIAL ABSCESS,20746050,CDM,983,RC,46050,HCPCS,outpatient,,,432.75,216.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INC THROMBOSED HEMORRHOID EXT,20746083,CDM,983,RC,46083,HCPCS,outpatient,,,455,227.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS AL FISSURE EXCISION,20746200,CDM,983,RC,46200,HCPCS,outpatient,,,505.75,252.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PAPILLECTOMY OR EXCISION SNGL TAG,20746220,CDM,983,RC,46220,HCPCS,outpatient,,,376,188,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS HEMORRHOIDECTOMY SIMPLE LIGATURE,20746221,CDM,983,RC,46221,HCPCS,outpatient,,,472.25,236.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION EXT HEMORRHOID,20746230,CDM,983,RC,46230,HCPCS,outpatient,,,610,305,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS HEMORRHOIDECTOMY EXT >=2,20746250,CDM,983,RC,46250,HCPCS,outpatient,,,1358.5,679.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS BOTOX OF AL FISSURE,20746505,CDM,983,RC,46505,HCPCS,outpatient,,,624.5,312.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ANOSCOPY DIAG COLLECTION OF SPECIMEN,20746600,CDM,983,RC,46600,HCPCS,outpatient,,,167,83.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ANOSCOPY DIAG W BIOPSY,20746606,CDM,983,RC,46606,HCPCS,outpatient,,,346.25,173.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ANOSCOPY W ABLATION,20746615,CDM,983,RC,46615,HCPCS,outpatient,,,277,138.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DESTRUCTION LESION ANUS SIMPLE ELECTR,20746910,CDM,983,RC,46910,HCPCS,outpatient,,,351.5,175.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of gallbladder using an endoscope,20747562,CDM,983,RC,47562,HCPCS,outpatient,,,2156.25,1078.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CHOLECYSTECTOMY,20747600,CDM,983,RC,47600,HCPCS,outpatient,,,3073.5,1536.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 EXPLORATORY LAPAROTOMY,20749000,CDM,983,RC,49000,HCPCS,outpatient,,,2270.25,1135.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OMENTECTOMY EPIPLOECTOMY RESECT OMEN,20749255,CDM,983,RC,49255,HCPCS,outpatient,,,945.75,472.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Repair of groin hernia patient age 5 years or older,20749505,CDM,983,RC,49505,HCPCS,outpatient,,,1500.25,750.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
RPR RECURRENT INGUIL HERNIA RED,20749520,CDM,983,RC,49520,HCPCS,outpatient,,,1839.25,919.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RPR INITIAL FEMORAL HERNIA INC,20749553,CDM,983,RC,49553,HCPCS,outpatient,,,1827,913.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RPR INITIAL INCISIOL VENTRAL HERNIA,20749560,CDM,983,RC,49560,HCPCS,outpatient,,,2166,1083,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RPR INITIAL INCISIOL VENTRAL HERNIA,20749561,CDM,983,RC,49561,HCPCS,outpatient,,,2734.75,1367.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RPR RECURRENT INCISIOL VENTRAL HERN,20749565,CDM,983,RC,49565,HCPCS,outpatient,,,2239.75,1119.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
REPAIR EPIGASTRIC HERNIA REDUCIBLE,20749570,CDM,983,RC,49570,HCPCS,outpatient,,,1166,583,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Repair of umbilical hernia in patients over 5 years old,20749585,CDM,983,RC,49585,HCPCS,outpatient,,,1261.75,630.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REPAIR UMBILICAL HERNIA 5YR+ INC,20749587,CDM,983,RC,49587,HCPCS,outpatient,,,1502,751,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Inguil hernia repair done by laparoscope,20749650,CDM,983,RC,49650,HCPCS,outpatient,,,1241.25,620.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPROSCOPY SURG RPR VENTRAL UMBIL HER,20749652,CDM,983,RC,49652,HCPCS,outpatient,,,2334.75,1167.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPROSCOPY SURG RPR VENTRAL UMB HERNI,20749653,CDM,983,RC,49653,HCPCS,outpatient,,,2995.75,1497.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SUTURE SECONDARY ABD WALL EVISCERATIO,20749900,CDM,983,RC,49900,HCPCS,outpatient,,,2294.75,1147.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INJECTION PROCEDURE CYSTO/VOID URETHR,20751600,CDM,983,RC,51600,HCPCS,outpatient,,,139.25,69.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CATH INDWELLING SIMPLE,20751702,CDM,983,RC,51702,HCPCS,outpatient,,,287,143.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CHANGE CYSTOSTOMY TUBE,20751705,CDM,983,RC,51705,HCPCS,outpatient,,,351.75,175.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CLOSURE OF CYSTOSTOMY,20751880,CDM,983,RC,51880,HCPCS,outpatient,,,1318.75,659.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DRAIGE SCROTAL WALL ABSCESS,20755100,CDM,983,RC,55100,HCPCS,outpatient,,,738.75,369.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION LESION SPERMATIC CORD,20755520,CDM,983,RC,55520,HCPCS,outpatient,,,1480.5,740.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INCISION AND DRAIGE VULVA PERINEAL,20756405,CDM,983,RC,56405,HCPCS,outpatient,,,442,221,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 DRAIN EXT EAR ABSCESS HEMATOMA SIMP,20769000,CDM,983,RC,69000,HCPCS,outpatient,,,296.25,148.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS BIOPSY EXTERL EAR,20769100,CDM,983,RC,69100,HCPCS,outpatient,,,124.25,62.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 REMOVAL IMPACTED CERUMEN IRRIG LAVAGE,20769209,CDM,983,RC,69209,HCPCS,outpatient,,,22.75,11.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Ultrasound of head and neck,20776536,CDM,983,RC,76536,HCPCS,outpatient,,,110.25,55.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Ultrasound of abdomen with all areas scanned,20776700,CDM,983,RC,76700,HCPCS,outpatient,,,158.5,79.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
A diagnostic procedure that allows a provider to see the organs and other structures in the abdomen,20776705,CDM,983,RC,76705,HCPCS,outpatient,,,85.75,42.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Ultrasound of back wall of the abdomen with all areas viewed,20776770,CDM,983,RC,76770,HCPCS,outpatient,,,145,72.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Ultrasound of back wall of the abdomen with limited areas viewed,20776775,CDM,983,RC,76775,HCPCS,outpatient,,,119,59.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Diagnostic ultrasound of an extremity excluding the bone, joints or vessels",20776882,CDM,983,RC,76882,HCPCS,outpatient,,,114,57,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS US GUIDE FOR NEEDLE PLACEMENT,20776942,CDM,983,RC,76942,HCPCS,outpatient,,,134.5,67.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Complete bilateral study of the extremities,20793970,CDM,983,RC,93970,HCPCS,outpatient,,,89.25,44.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
One sided or limited bilateral study,20793971,CDM,983,RC,93971,HCPCS,outpatient,,,58.5,29.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Debridement (for example, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps)",20797597,CDM,983,RC,97597,HCPCS,outpatient,,,130,65,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 DEBRIDMT EPT/DERMIS EA ADDTL 20 SQCM,20797598,CDM,983,RC,97598,HCPCS,outpatient,,,180.5,90.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 REMOVAL OF DEVITALIZED TISSUE,20797602,CDM,983,RC,97602,HCPCS,outpatient,,,83.5,41.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 WOUND VAC 50  SQCM OR LESS,20797605,CDM,983,RC,97605,HCPCS,outpatient,,,81.75,40.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 WOUND VAC OVER 50 SQCM,20797606,CDM,983,RC,97606,HCPCS,outpatient,,,88.25,44.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 NEGATIVE PRESSURE SP THER <=50 SQ C,20797607,CDM,983,RC,97607,HCPCS,outpatient,,,56.75,28.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 GLOBAL,20799024,CDM,969,RC,99024,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 10 minutes",20799202,CDM,983,RC,99202,HCPCS,outpatient,,,107,53.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 30 min",20799203,CDM,983,RC,99203,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 45 min",20799204,CDM,983,RC,99204,HCPCS,outpatient,,,265,132.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 60 min",20799205,CDM,983,RC,99205,HCPCS,outpatient,,,343.5,171.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient not requiring a physician,20799211,CDM,983,RC,99211,HCPCS,outpatient,,,24.5,12.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient requiring a physician,20799212,CDM,983,RC,99212,HCPCS,outpatient,,,56.5,28.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",20799213,CDM,983,RC,99213,HCPCS,outpatient,,,106.25,53.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 25 minutes",20799214,CDM,983,RC,99214,HCPCS,outpatient,,,162,81,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient, visit typically 40 minutes",20799215,CDM,983,RC,99215,HCPCS,outpatient,,,228.75,114.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OBSERVATION DISCHARGE,20799217,CDM,983,RC,99217,HCPCS,outpatient,,,173.5,86.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OBSERVATION CARE INITIAL LOW,20799218,CDM,983,RC,99218,HCPCS,outpatient,,,165.25,82.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OBSERVATION CARE INITIAL MODERATE,20799219,CDM,983,RC,99219,HCPCS,outpatient,,,270.75,135.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OBSERVATION CARE INITIAL HIGH,20799220,CDM,983,RC,99220,HCPCS,outpatient,,,377.5,188.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INITIAL HOSPITAL CARE LOW,20799221,CDM,987,RC,99221,HCPCS,outpatient,,,234.25,117.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INITIAL HOSPITAL CARE MODERATE,20799222,CDM,987,RC,99222,HCPCS,outpatient,,,318.5,159.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INITIAL HOSPITAL CARE HIGH,20799223,CDM,987,RC,99223,HCPCS,outpatient,,,465.25,232.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SUBSEQUENT OBSERV CARE PROB FOC,20799224,CDM,982,RC,99224,HCPCS,outpatient,,,78.75,39.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SUB OV CARE MOD COMP,20799225,CDM,982,RC,99225,HCPCS,outpatient,,,137,68.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 SUBSEQ OBS HIGH COMPLEXITY,20799226,CDM,982,RC,99226,HCPCS,outpatient,,,203,101.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SUBSEQUENT HOSPITAL CARE LOW,20799231,CDM,987,RC,99231,HCPCS,outpatient,,,99,49.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SUBSEQUENT HOSPITAL CARE MODERATE,20799232,CDM,987,RC,99232,HCPCS,outpatient,,,174.75,87.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SUBSEQUENT HOSPITAL CARE HIGH,20799233,CDM,987,RC,99233,HCPCS,outpatient,,,248.25,124.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS OBS IP ADMIT DISC SAME DAY LOW,20799234,CDM,987,RC,99234,HCPCS,outpatient,,,329.75,164.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS HOSPITAL DISCHARGE DAY MGMT < 30 MIN,20799238,CDM,987,RC,99238,HCPCS,outpatient,,,172.25,86.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ER SCREEN MINIMAL,20799281,CDM,981,RC,99281,HCPCS,outpatient,,,54.5,27.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ER PAT /LOW,20799282,CDM,981,RC,99282,HCPCS,outpatient,,,104.5,52.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, moderately severe problem",20799283,CDM,981,RC,99283,HCPCS,outpatient,,,164.75,82.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem of high severity",20799284,CDM,981,RC,99284,HCPCS,outpatient,,,307.75,153.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem with significant threat to life or function",20799285,CDM,981,RC,99285,HCPCS,outpatient,,,458.25,229.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS CRITICAL CARE 1ST HOUR,20799291,CDM,987,RC,99291,HCPCS,outpatient,,,641.75,320.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INIT NURSING FACILITY CARE/DAY LOW,20799304,CDM,983,RC,99304,HCPCS,outpatient,,,208,104,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 INIT NURSING FACILITY CARE PER DAY MO,20799305,CDM,983,RC,99305,HCPCS,outpatient,,,289.25,144.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SUBSEQUENT NRSG FAC PROB FOCUSED,20799307,CDM,983,RC,99307,HCPCS,outpatient,,,105,52.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SUBS NURS FAC LOW,20799308,CDM,983,RC,99308,HCPCS,outpatient,,,157.5,78.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SUBS NRSING FACILITY CARE PER DAY MOD,20799309,CDM,983,RC,99309,HCPCS,outpatient,,,208.25,104.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS NURSING FACILITY CARE DISCHARGE DAY,20799315,CDM,983,RC,99315,HCPCS,outpatient,,,152.75,76.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 EP DOMICILIARY E/M STRAIGHTFORWARD,20799334,CDM,982,RC,99334,HCPCS,outpatient,,,109,54.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 HOME VISIT NP PROBLEM FOCUSED,20799341,CDM,983,RC,99341,HCPCS,outpatient,,,125.5,62.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 HOME VISIT NP MOD SEVERITY,20799342,CDM,983,RC,99342,HCPCS,outpatient,,,177.25,88.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 HOME VISIT NEW DET EXAM MOD COMPLEX,20799343,CDM,983,RC,99344,HCPCS,outpatient,,,285.75,142.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 HOME VISIT PROBLEM FOCUSED,20799347,CDM,983,RC,99347,HCPCS,outpatient,,,123.75,61.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 HOME VISIT EXPANDED LOW COMPLEX,20799348,CDM,983,RC,99348,HCPCS,outpatient,,,185.75,92.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 HOME VISIT DETAILED MOD COMPLEXITY,20799349,CDM,983,RC,99349,HCPCS,outpatient,,,271.25,135.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial new patient preventive medicine evaluation (40?4 years),20799386,CDM,983,RC,99386,HCPCS,outpatient,,,220,110,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Established patient periodic preventive medicine examition age 18-39 years,20799395,CDM,983,RC,99395,HCPCS,outpatient,,,158.25,79.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 SMOKING CESSATION COUNSELING 3-10 MIN,20799406,CDM,983,RC,99406,HCPCS,outpatient,,,27.25,13.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
S1 PHYSICAL FOR EMPLOYMENT,20799499,CDM,983,RC,,,outpatient,,,137.25,68.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient not requiring a physician,20799996,CDM,983,RC,99211,HCPCS,outpatient,,,103.5,51.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,20799998,CDM,983,RC,G0121,HCPCS,outpatient,,,1377,688.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Colorectal cancer screening; colonoscopy on individual at high risk,20799999,CDM,983,RC,G0105,HCPCS,outpatient,,,1377,688.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG GLOBAL FOR OTHER PROVIDER,20900024,CDM,969,RC,99024,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG COUNSELING LUNG CANCER SCREEN LDCT,20900296,CDM,983,RC,G0296,HCPCS,outpatient,,,49.75,24.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG ADJUST GASTRIC BAND DIAMETER,20902083,CDM,983,RC,S2083,HCPCS,outpatient,,,139.5,69.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG TUBE THORACOSTOMY RT,20902551,CDM,983,RC,32551,HCPCS,outpatient,,,592.5,296.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG LAPAROSCOPY SURGL GASTROSTOMY ASSIST,20903653,CDM,983,RC,43653,HCPCS,outpatient,,,322.25,161.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG GASTRIC RESTRICT PROC W/O BYPASS ASSI,20903843,CDM,983,RC,43843,HCPCS,outpatient,,,662.25,331.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG REDUCTION VOLVULUS INTUS HERN ASSIST,20904050,CDM,983,RC,44050,HCPCS,outpatient,,,539,269.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG ADJ TISS TRANSF DEFECT 30.1-60.0 ASSI,20904301,CDM,983,RC,14301,HCPCS,outpatient,,,477.5,238.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG ADJ TISS TRANSF DEF ADDTL 30.0 ASSIST,20904302,CDM,983,RC,14302,HCPCS,outpatient,,,126.5,63.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG LAPAROSCOPIC LIVER BIOPSY ASSIST,20907379,CDM,983,RC,47379,HCPCS,outpatient,,,326,163,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG REMOVAL OF SPLEEN TOTAL ASSIST,20908100,CDM,983,RC,38100,HCPCS,outpatient,,,593.5,296.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG GLOBAL HOLEHOUSE PT,20909024,CDM,969,RC,99024,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 45 min",20909204,CDM,983,RC,99204,HCPCS,outpatient,,,257,128.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 25 minutes",20909214,CDM,983,RC,99214,HCPCS,outpatient,,,162,81,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG ER PT LEVEL 1 MOD 25,20909281,CDM,981,RC,99281,HCPCS,outpatient,,,54.5,27.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG ER PT LEVEL 2 MOD 25,20909282,CDM,981,RC,99282,HCPCS,outpatient,,,106.5,53.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, moderately severe problem",20909283,CDM,981,RC,99283,HCPCS,outpatient,,,164.75,82.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem of high severity",20909284,CDM,981,RC,99284,HCPCS,outpatient,,,307.75,153.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem with significant threat to life or function",20909285,CDM,981,RC,99285,HCPCS,outpatient,,,458.25,229.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG MASTECTOMY PARTIAL ASSIST,20909301,CDM,983,RC,19301,HCPCS,outpatient,,,1755.75,877.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RPR INITIAL INCISION VENT HERN ASSIST,20909561,CDM,983,RC,49561,HCPCS,outpatient,,,547.75,273.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG IMPLANTATION MESH OPEN HERN RPRASSIST,20909568,CDM,983,RC,49568,HCPCS,outpatient,,,166.5,83.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Fine Needle Aspiration Biopsy without imaging,20910021,CDM,983,RC,10021,HCPCS,outpatient,,,192.25,96.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Incision and draige of abscess; simple or single and complex or multiple,20910060,CDM,983,RC,10060,HCPCS,outpatient,,,239.25,119.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG INC DRAIN ABSCESS MULTIPLE,20910061,CDM,983,RC,10061,HCPCS,outpatient,,,430,215,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG INC DRAIN PILONIDAL CYST SIMPLE,20910080,CDM,983,RC,10080,HCPCS,outpatient,,,176,88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG INC DRAIN PILONIDAL CYST COMPLICATED,20910081,CDM,983,RC,10081,HCPCS,outpatient,,,624.5,312.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG INC REMOVAL FOREIGN BODY SIMPLE,20910120,CDM,983,RC,10120,HCPCS,outpatient,,,236.25,118.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Incision and draige of hematoma, seroma or fluid collection",20910140,CDM,983,RC,10140,HCPCS,outpatient,,,309,154.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Puncture aspiration of abscess, hematoma, bulla, or cyst",20910160,CDM,983,RC,10160,HCPCS,outpatient,,,247.5,123.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG INC DRAIN COMPLEX POSTOP WOUND INF,20910180,CDM,983,RC,10180,HCPCS,outpatient,,,458.75,229.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG DEBRIDE NECROTIZING SOFT TIS INF PERI,20911004,CDM,983,RC,11004,HCPCS,outpatient,,,1594.25,797.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG DEBRIDEMENT SKIN SUBCUT TISSUE,20911042,CDM,983,RC,11042,HCPCS,outpatient,,,135.25,67.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"SG DEBRIDEMENT SKIN, SUBCU MUSCLE",20911043,CDM,983,RC,11043,HCPCS,outpatient,,,600.25,300.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG DEBRIDE SUBQ BONE,20911044,CDM,983,RC,11044,HCPCS,outpatient,,,823.25,411.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG DEBRIDMT SUBQ E/ADDTL 20 SQCM,20911045,CDM,983,RC,11045,HCPCS,outpatient,,,45.25,22.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG DEBRIDMT MUSCLES E/ADDTL 20 SQCM,20911046,CDM,983,RC,11046,HCPCS,outpatient,,,90,45,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG DEBRIDMT BONE E/ADDTL 20 SQCM,20911047,CDM,983,RC,11047,HCPCS,outpatient,,,153.75,76.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG PUNCH BX SKIN SINGLE LESION,20911104,CDM,983,RC,11104,HCPCS,outpatient,,,118.25,59.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Removal of skin tags, multiple fibrocutaneous tags, any area",20911200,CDM,983,RC,11200,HCPCS,outpatient,,,169.75,84.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG REMOVAL SKIN TAGS EA ADDTL 10 OR PART,20911201,CDM,983,RC,11201,HCPCS,outpatient,,,48.75,24.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION BEN .5 CM OR LESS TRUNK,20911400,CDM,983,RC,11400,HCPCS,outpatient,,,187,93.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Under Excision-Benign Lesions Procedures on the Skin 0.6-1 CM,20911401,CDM,983,RC,11401,HCPCS,outpatient,,,250.5,125.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION BEN 1.1 TO 2.0 CM,20911402,CDM,983,RC,11402,HCPCS,outpatient,,,278.75,139.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION BEN 2.1-3.0 CM TRUNK/ARM/LEG,20911403,CDM,983,RC,11403,HCPCS,outpatient,,,354.75,177.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION BEN 3.1-4.0 CM TRUNK/ARM/LEG,20911404,CDM,983,RC,11404,HCPCS,outpatient,,,395.75,197.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION BEN > 4.0 CM,20911406,CDM,983,RC,11406,HCPCS,outpatient,,,596.75,298.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION BENIGN <.5 CM,20911420,CDM,983,RC,11420,HCPCS,outpatient,,,205,102.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION BEN .6 TO 1.0 CM,20911421,CDM,983,RC,11421,HCPCS,outpatient,,,278,139,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Under Excision-Benign Lesions Procedures on the Skin 1.1-2 CM,20911422,CDM,983,RC,11422,HCPCS,outpatient,,,334,167,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION BEN 2.1 TO 3.0 CM,20911423,CDM,983,RC,11423,HCPCS,outpatient,,,391.25,195.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION BENIGN LESION 3.1 TO 4.0 CM,20911424,CDM,983,RC,11424,HCPCS,outpatient,,,453.75,226.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXC BENIGN LESION >4.0 CM SCALP NECK,20911426,CDM,983,RC,11426,HCPCS,outpatient,,,760,380,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION BEN LESION <.5 CM,20911440,CDM,983,RC,11440,HCPCS,outpatient,,,240,120,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION BEN LESION .6 TO 1.0 CM,20911441,CDM,983,RC,11441,HCPCS,outpatient,,,318.75,159.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION BEN LESION 1.1 TO 2.0 CM,20911442,CDM,983,RC,11442,HCPCS,outpatient,,,356.75,178.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION BEN LESION 2.1 TO 3.0 CM,20911443,CDM,983,RC,11443,HCPCS,outpatient,,,445.25,222.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION SKIN/SUBCUT HIDRADENITIS ING,20911462,CDM,983,RC,11462,HCPCS,outpatient,,,565.75,282.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION SKIN & SUBC HID PERI ING SI,20911470,CDM,983,RC,11470,HCPCS,outpatient,,,676.25,338.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Excision-Malignt Lesions,20911602,CDM,983,RC,11602,HCPCS,outpatient,,,400.5,200.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXC MALIG LES TRUNK ARM LEG 2.1 - 3CM,20911603,CDM,983,RC,11603,HCPCS,outpatient,,,478.5,239.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXC MALIG LES TRUNK ARM LEG 3.1 - 4CM,20911604,CDM,983,RC,11604,HCPCS,outpatient,,,529,264.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION MALIG > 4.0 CM TRUNK ARM LEG,20911606,CDM,983,RC,11606,HCPCS,outpatient,,,792.5,396.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"SG EXC MALIG LES SCALP, NECK, HANDS FEET",20911624,CDM,983,RC,11624,HCPCS,outpatient,,,604.25,302.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION MAL LES >4.0 CM SCALP NECK H,20911626,CDM,983,RC,11626,HCPCS,outpatient,,,767.5,383.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION MALIG .6 TO 1.0 CM,20911641,CDM,983,RC,11641,HCPCS,outpatient,,,395.75,197.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION MALIG >4.0 CM,20911646,CDM,983,RC,11646,HCPCS,outpatient,,,1045,522.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION PILONIDAL CYST SINUS EXT,20911771,CDM,983,RC,11771,HCPCS,outpatient,,,1068,534,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION PILONIDAL CYST SINUS COMP,20911772,CDM,983,RC,11772,HCPCS,outpatient,,,1378,689,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG REMOVAL NONBIODEGRADABLE DRUG DELIVE,20911982,CDM,983,RC,11982,HCPCS,outpatient,,,275.5,137.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG LAYER CLOSE WOUNDS < 2.5 CM,20912031,CDM,983,RC,12031,HCPCS,outpatient,,,400.5,200.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAYER CLOSE WOUNDS 2.6 TO 7.5 CM,20912032,CDM,983,RC,12032,HCPCS,outpatient,,,485.25,242.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG LAYER CLOSE WOUNDS 7.6-12.5 CM SCALP,20912034,CDM,983,RC,12034,HCPCS,outpatient,,,518.25,259.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG LAYER CLOSE WOUNDS 12.6 TO 20.0 CM,20912035,CDM,983,RC,12035,HCPCS,outpatient,,,615.75,307.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG LAYER CLOSE WOUNDS 2.6 TO 7.5 CM,20912042,CDM,983,RC,12042,HCPCS,outpatient,,,356.5,178.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG LAYER CLOSE WOUNDS >2.5 CM,20912051,CDM,983,RC,12051,HCPCS,outpatient,,,458.75,229.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG LAYER CLOSE WOUNDS 5.1 TO 7.5 CM,20912053,CDM,983,RC,12053,HCPCS,outpatient,,,549.25,274.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG REPAIR INTERMEDIATE 7.6-12.5 CM FACE,20912054,CDM,983,RC,12054,HCPCS,outpatient,,,588.25,294.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG REPAIR COMPLEX SCALP ARM 2.6-7.5 CM,20913121,CDM,983,RC,13121,HCPCS,outpatient,,,811.25,405.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG REPAIR COMPLEX EA ADD 5CM LESS SCALP,20913122,CDM,983,RC,13122,HCPCS,outpatient,,,232.5,116.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG REPAIR COMPLEX FOREHEAD 2.6 TO 7.5 CM,20913132,CDM,983,RC,13132,HCPCS,outpatient,,,1166.75,583.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG SECONDARY CLOSURE SURGICAL,20913160,CDM,983,RC,13160,HCPCS,outpatient,,,2366.75,1183.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG FULL THICKNESS GRAFT < 20 SQ CM,20915220,CDM,983,RC,15220,HCPCS,outpatient,,,1566,783,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION SKIN/SUBQ ABDOMEN,20915830,CDM,983,RC,15830,HCPCS,outpatient,,,2533,1266.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION EXCESS SKIN SUBQ ABDOMEN TIS,20915847,CDM,983,RC,15847,HCPCS,outpatient,,,1228.75,614.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG DRESS AND OR DEBRIDE SMALL PART THICK,20916020,CDM,983,RC,16020,HCPCS,outpatient,,,108.25,54.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG DRESS AND OR  DEBRIDE MED PART THICK,20916025,CDM,983,RC,16025,HCPCS,outpatient,,,307.75,153.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of 1-14 common or plantar warts,20917110,CDM,983,RC,17110,HCPCS,outpatient,,,167.75,83.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of >15 common or plantar warts,20917111,CDM,983,RC,17111,HCPCS,outpatient,,,209.5,104.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Chemical destruction of pre-cancerous lesions of the skin,20917250,CDM,983,RC,17250,HCPCS,outpatient,,,98.75,49.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
REMOVAL OF BREAST LESION,20919120,CDM,983,RC,19120,HCPCS,outpatient,,,1023.75,511.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXPLORATION PENETRATING WOUND NECK,20920100,CDM,983,RC,20100,HCPCS,outpatient,,,1788.5,894.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXPLORATION PENETRATING WOUND EXTREM,20920103,CDM,983,RC,20103,HCPCS,outpatient,,,939.75,469.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG CARPAL TUNNEL INJECTION,20920526,CDM,983,RC,20526,HCPCS,outpatient,,,162.25,81.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Injection of medication into a tendon or ligament,20920550,CDM,983,RC,20550,HCPCS,outpatient,,,86.75,43.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a small joint/bursa without ultrasound,20920600,CDM,983,RC,20600,HCPCS,outpatient,,,85.5,42.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a large joint/bursa without ultrasound,20920605,CDM,983,RC,20605,HCPCS,outpatient,,,92.75,46.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a major joint/bursa without ultrasound,20920610,CDM,983,RC,20610,HCPCS,outpatient,,,112.75,56.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of fluid or injection of medication into a ganglion cyst,20920612,CDM,983,RC,20612,HCPCS,outpatient,,,123.75,61.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION TUMOR SOFT TIS <2 CM FACE/SC,20921011,CDM,983,RC,21011,HCPCS,outpatient,,,644.5,322.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION SOFT TISS NECK THORAX SQ 3CM,20921552,CDM,983,RC,21552,HCPCS,outpatient,,,1211.25,605.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG PARTIAL REMOVAL STERNUM/XIPHOID,20921620,CDM,983,RC,21620,HCPCS,outpatient,,,1366.75,683.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION TUM SOFT TISS BACK SUBQ 3CM>,20921931,CDM,983,RC,21931,HCPCS,outpatient,,,1273,636.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXC TUMOR SOFT TISSUE BACK SUBFASCIAL,20921933,CDM,983,RC,21933,HCPCS,outpatient,,,2302.75,1151.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS INCISON & DRAIGE OPEN DEEP ABS POST,20922010,CDM,983,RC,22010,HCPCS,outpatient,,,2502.5,1251.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS EXCISION TUM SOFT TIS SHOULDER SUBQ 3,20923071,CDM,983,RC,23071,HCPCS,outpatient,,,1092.5,546.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION TUMOR SOFT TIS UP ARM ELBOW>,20924071,CDM,983,RC,24071,HCPCS,outpatient,,,1133.75,566.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION TUMOR SOFT TISS UP ARM ELBOW,20924073,CDM,983,RC,24073,HCPCS,outpatient,,,2114.75,1057.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REMOVAL FB UPPER ARM/ELBOW DEEP,20924201,CDM,983,RC,24201,HCPCS,outpatient,,,983.25,491.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION TUMOR FOREARM WRIST 3CM >,20925073,CDM,983,RC,25073,HCPCS,outpatient,,,1512.5,756.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXC GANGLION WRIST PRIM,20925111,CDM,983,RC,25111,HCPCS,outpatient,,,884.25,442.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXC GANGLION WRIST RECURRENT,20925112,CDM,983,RC,25112,HCPCS,outpatient,,,1092.25,546.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG REPAIR TENDON MUSCL FLEX FOREARM WRIS,20925260,CDM,983,RC,25260,HCPCS,outpatient,,,1718,859,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DRAIN FINGER ABS COMP,20926011,CDM,983,RC,26011,HCPCS,outpatient,,,1045,522.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG RELEASE TENDON SHEATH,20926055,CDM,983,RC,26055,HCPCS,outpatient,,,1606.25,803.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXC LESION TENDON SHEATH JT CAPSULE,20926160,CDM,983,RC,26160,HCPCS,outpatient,,,1532.25,766.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG REPAIR FLEXOR TENDON PRIMARY EACH,20926356,CDM,983,RC,26356,HCPCS,outpatient,,,2553.25,1276.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
OS AMPUTATION FINGER THUMB SINGLE W/DIRE,20926951,CDM,983,RC,26951,HCPCS,outpatient,,,1490,745,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION TUM SOFT TIS THIGH SUBQ 3CM>,20927337,CDM,983,RC,27337,HCPCS,outpatient,,,1125,562.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION SOFT TISS TUMOR LEG/ANK >3CM,20927632,CDM,983,RC,27632,HCPCS,outpatient,,,1109.75,554.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RPR FLEXOR TENDON LEG PRIMARY,20927658,CDM,983,RC,27658,HCPCS,outpatient,,,1993.5,996.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG DECOMPRESSION FASCIOTOMY LEG ANT/LAT,20927892,CDM,983,RC,27892,HCPCS,outpatient,,,1489,744.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION OF LESION TENDON /SHEATH,20928090,CDM,983,RC,28090,HCPCS,outpatient,,,836.75,418.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"GS REMOVAL OF FOREIGN BODY, FOOT SUBC",20928190,CDM,983,RC,28190,HCPCS,outpatient,,,559.75,279.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"SG REMOVAL OF FOREIGN BODY, FOOT DEEP",20928192,CDM,983,RC,28192,HCPCS,outpatient,,,1164,582,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS AMPUTATION TOE METATARSOPHALANGEAL JT,20928820,CDM,983,RC,28820,HCPCS,outpatient,,,1401.25,700.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Flexible, fiberoptic diagnostic laryngoscopy",20931575,CDM,983,RC,31575,HCPCS,outpatient,,,200.5,100.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG BRONCHOSCOPY DX CELL WASHING,20931622,CDM,983,RC,31622,HCPCS,outpatient,,,255,127.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG PLEURAL SCARIFICATION REPEAT PNEUMOTH,20932215,CDM,983,RC,32215,HCPCS,outpatient,,,2150.25,1075.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG INSERTION INDWEL TUN PLEUR CATH W/CUF,20932550,CDM,983,RC,32550,HCPCS,outpatient,,,500,250,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG TUBE THORACOSTOMY LT,20932551,CDM,983,RC,32551,HCPCS,outpatient,,,592.5,296.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG THORACENTESIS NEEDLECATH ASP PLE W/O,20932554,CDM,983,RC,32554,HCPCS,outpatient,,,305.75,152.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PLEURAL DRAIGE W/INDWELLING CATHETE,20932556,CDM,983,RC,32556,HCPCS,outpatient,,,387.75,193.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG INSTILLATION VIA CHEST TUBE PLEURODES,20932560,CDM,983,RC,32560,HCPCS,outpatient,,,315,157.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG REPAIR BLOOD VESSEL UPPER EXTREMITY,20935206,CDM,983,RC,35206,HCPCS,outpatient,,,2222.75,1111.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG REPAIR BLOOD VESSEL LOWER EXTREM DIRE,20935226,CDM,983,RC,35226,HCPCS,outpatient,,,2548.5,1274.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXPLORE POSTOP HEMM ABDOMEN,20935840,CDM,960,RC,35840,HCPCS,outpatient,,,2015.25,1007.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG INSERTION NON-TUNNELED VENOUS CATH,20936556,CDM,983,RC,36556,HCPCS,outpatient,,,685,342.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG INSERTION TUNNELED CENTRALLY INSERTED,20936558,CDM,983,RC,36558,HCPCS,outpatient,,,2285.75,1142.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG INSERTION CVAD W/PORT 5YR OR >,20936561,CDM,983,RC,36561,HCPCS,outpatient,,,3263.25,1631.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG INSERTION PERIPHERAL CENTRAL VAD W/O,20936569,CDM,983,RC,36569,HCPCS,outpatient,,,309.75,154.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG CATH REMOVAL TUNNELED W/O PUMP,20936589,CDM,983,RC,36589,HCPCS,outpatient,,,512,256,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG CATH REMOVAL TUNNELED W PUMP,20936590,CDM,983,RC,36590,HCPCS,outpatient,,,831.25,415.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG ARTERIAL CATH PERCUTANEOUS,20936620,CDM,983,RC,36620,HCPCS,outpatient,,,122.75,61.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SPLENECTOMY PARTIAL,20938101,CDM,983,RC,38101,HCPCS,outpatient,,,3171.25,1585.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG BIOPSY EXCISION LYMPH NODE OPEN,20938500,CDM,983,RC,38500,HCPCS,outpatient,,,900.75,450.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG BIOPSY EXCISION LYMPH NODES OPEN DEEP,20938525,CDM,983,RC,38525,HCPCS,outpatient,,,1089.5,544.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG BIOPSY EXC LYMPH NODE OPEN INGUINOFEM,20938531,CDM,983,RC,38531,HCPCS,outpatient,,,794.75,397.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG ESOPHAGOSCOPY DIAG,20943200,CDM,983,RC,43200,HCPCS,outpatient,,,588.25,294.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ESOPHAGOSCOPY FLEX TRANSORAL W/ BX,20943202,CDM,983,RC,43202,HCPCS,outpatient,,,209.5,104.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG ESOPHAGOSCOPY FLEX TRANS REMOVE FB,20943215,CDM,983,RC,43215,HCPCS,outpatient,,,343,171.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Diagnostic examition of esophagus, stomach, and/or upper small bowel using an endoscope",20943235,CDM,983,RC,43235,HCPCS,outpatient,,,595.25,297.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope",20943239,CDM,983,RC,43239,HCPCS,outpatient,,,692.75,346.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EGD WITH PLACEMENT OF PEG TUBE,20943246,CDM,983,RC,43246,HCPCS,outpatient,,,559.75,279.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EGD FLEX REMOVAL FB,20943247,CDM,983,RC,43247,HCPCS,outpatient,,,446.75,223.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EGD W BALLOON DIL ESOPHAGUS,20943249,CDM,983,RC,43249,HCPCS,outpatient,,,388.25,194.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EGD FLEX TRANS REMOVE TUMOR POLYP HOT,20943250,CDM,983,RC,43250,HCPCS,outpatient,,,417.5,208.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS UPPER GASTROINTESTIL ENDOSCOPY,20943251,CDM,983,RC,43251,HCPCS,outpatient,,,484,242,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG UPPER GASTROINTESTIL ENDOSCOPY,20943255,CDM,983,RC,43255,HCPCS,outpatient,,,629.75,314.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG ENDOSCOPIC RETROGRADE CHOLANGIO,20943261,CDM,983,RC,43261,HCPCS,outpatient,,,810,405,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG LAP ESOPHAGOMYOTOMY W/FUNDOPLASTY,20943279,CDM,983,RC,43279,HCPCS,outpatient,,,3436.25,1718.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG LAPAROSCOPY SURGICAL REPAIR PARAESO,20943281,CDM,983,RC,43281,HCPCS,outpatient,,,4936.5,2468.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG RPR PARAESOPH HIATAL HERN OPEN W/O ME,20943332,CDM,983,RC,43332,HCPCS,outpatient,,,3103.25,1551.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG DILATION OF ESOPHAGUS OVER GUIDE WIRE,20943453,CDM,983,RC,43453,HCPCS,outpatient,,,589,294.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG ESOPHAGOGASTRIC TAMPODE W BALLOON,20943460,CDM,983,RC,43460,HCPCS,outpatient,,,598.75,299.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS GASTROTOMY W FB REMOVAL,20943500,CDM,983,RC,43500,HCPCS,outpatient,,,2158.25,1079.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG REPLACEMENT GASTROSTOMY TUBE,20943762,CDM,983,RC,43762,HCPCS,outpatient,,,69.25,34.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS GASTROSTOMY OPEN WO GASTRIC TUBE,20943830,CDM,983,RC,43830,HCPCS,outpatient,,,2005.5,1002.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG GASTRORRAPHY SUTURE GASTRIC ULCER,20943840,CDM,983,RC,43840,HCPCS,outpatient,,,3399.25,1699.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG UNLISTED PROC STOMACH RESECTION,20943999,CDM,983,RC,43999,HCPCS,outpatient,,,3399.25,1699.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG REDUCTION VOLVULUS INTUSSUSCEPTION,20944050,CDM,983,RC,44050,HCPCS,outpatient,,,2693,1346.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG ENTERECTOMY RESECTION SMALL INTESTINE,20944120,CDM,983,RC,44120,HCPCS,outpatient,,,3576.25,1788.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG MOBILIZATION OF SPLENIC FLEXURE COLEC,20944139,CDM,983,RC,44139,HCPCS,outpatient,,,378.75,189.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG COLECTOMY PARTIAL W ASTOMOSIS,20944140,CDM,983,RC,44140,HCPCS,outpatient,,,3966,1983,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG COLECTOMY PARTIAL W ASTOMOSIS,20944144,CDM,983,RC,44144,HCPCS,outpatient,,,5037.25,2518.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG COLECTOMY PARTIAL TERM ILEUM,20944160,CDM,983,RC,44160,HCPCS,outpatient,,,3646,1823,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAPAROSCOPY COLECTOMY PARTIAL W AS,20944204,CDM,983,RC,44204,HCPCS,outpatient,,,4584.25,2292.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG LAP COLOSTOMY CLOSURE W/RESECTION,20944227,CDM,983,RC,44227,HCPCS,outpatient,,,4430.5,2215.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG ILEOSTOMY OR JEJUNOSTOMY NON TUBE,20944310,CDM,983,RC,44310,HCPCS,outpatient,,,3464.75,1732.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG COLOSTOMY OR SKIN LEVEL CECOSTOMY,20944320,CDM,983,RC,44320,HCPCS,outpatient,,,3219.5,1609.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG ENDOSCOPIC EVAL SMALL INTEST POUCH DI,20944385,CDM,983,RC,44385,HCPCS,outpatient,,,332,166,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Diagnostic examition of large bowel using an endoscope which is inserted through abdomil opening,20944388,CDM,983,RC,44388,HCPCS,outpatient,,,515.75,257.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG SUTURE SMALL INTESTINE FOR PERFORATED,20944602,CDM,983,RC,44602,HCPCS,outpatient,,,4037.5,2018.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG SUTURE SMALL INTESTINE FOR PERFORATED,20944603,CDM,983,RC,44603,HCPCS,outpatient,,,4622,2311,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG SUTURE LGE INTESTINE PERF ULCER/INJUR,20944604,CDM,983,RC,44604,HCPCS,outpatient,,,3135.75,1567.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG CLOSURE ENTROENTERIC/COLIC FISTULA,20944650,CDM,983,RC,44650,HCPCS,outpatient,,,3871.75,1935.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG CLOSURE ENTROVESICAL FISTULA INTEST/B,20944661,CDM,983,RC,44661,HCPCS,outpatient,,,4023.25,2011.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG APPENDECTOMY,20944950,CDM,983,RC,44950,HCPCS,outpatient,,,1891.5,945.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS APPENDECTOMY RUPTURED ABSCESS,20944960,CDM,983,RC,44960,HCPCS,outpatient,,,2537.75,1268.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG LAPAROSCOPY SURGICAL APPENDECTOMY,20944970,CDM,983,RC,44970,HCPCS,outpatient,,,1727.5,863.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG LAP APPENDECTOMY AT TIME OF MAJ PROCE,20944979,CDM,983,RC,44979,HCPCS,outpatient,,,891.75,445.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG I&D DEEP SUPRALEVATOR PELVICREC ABSCE,20945020,CDM,983,RC,45020,HCPCS,outpatient,,,1400.25,700.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"SG EXC RECTAL TUMOR, TRANSAL APPROACH",20945171,CDM,983,RC,45171,HCPCS,outpatient,,,1812.5,906.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG SIGMOIDOSCOPY FLEXIBLE DIAG INC SPECI,20945330,CDM,983,RC,45330,HCPCS,outpatient,,,138,69,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG SIGMOIDOSCOPY FLEXIBLE W BIOPSY,20945331,CDM,983,RC,45331,HCPCS,outpatient,,,336.25,168.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG SIGMOIDOSCOPY FLEX DIAG W HOT FORCEPS,20945333,CDM,983,RC,45333,HCPCS,outpatient,,,549.25,274.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG SIGMOIDOSCOPY FLEXIBLE REMOVAL,20945338,CDM,983,RC,45338,HCPCS,outpatient,,,623.75,311.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Diagnostic examition of large bowel using an endoscope,20945378,CDM,983,RC,45378,HCPCS,outpatient,,,795,397.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Biopsy of large bowel using an endoscope,20945380,CDM,983,RC,45380,HCPCS,outpatient,,,1205.75,602.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Injections of large bowel using an endoscope,20945381,CDM,983,RC,45381,HCPCS,outpatient,,,708.5,354.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of polyps or growths in large bowel using an endoscope,20945384,CDM,983,RC,45384,HCPCS,outpatient,,,942.5,471.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of polyps or growths of large bowel using an endoscope,20945385,CDM,983,RC,45385,HCPCS,outpatient,,,1080,540,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of large bowel growths using an endoscope,20945388,CDM,983,RC,45388,HCPCS,outpatient,,,921.75,460.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Tying of large bowel using an endoscope,20945398,CDM,983,RC,45398,HCPCS,outpatient,,,1205.75,602.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG REMOVAL FECAL IMPACTION FB UNDER ANES,20945915,CDM,983,RC,45915,HCPCS,outpatient,,,671.75,335.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG ANORECTAL EXAM SURGICAL ANES DIAG,20945990,CDM,983,RC,45990,HCPCS,outpatient,,,325.25,162.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG PLACEMENT OF SETON,20946020,CDM,983,RC,46020,HCPCS,outpatient,,,552.75,276.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG INC & DRAIN PERIAL ABSCESS,20946050,CDM,983,RC,46050,HCPCS,outpatient,,,432,216,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG INC THROMBOSED HEMORRHOID EXT,20946083,CDM,983,RC,46083,HCPCS,outpatient,,,455,227.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG PAPILLECTOMY OR EXCISION SNGL TAG,20946220,CDM,983,RC,46220,HCPCS,outpatient,,,376,188,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG HEMORRHOIDECTOMY INT RUBBER BAND,20946221,CDM,983,RC,46221,HCPCS,outpatient,,,472.25,236.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION EXT PAPILLAE/TAGS ANUS MULTI,20946230,CDM,983,RC,46230,HCPCS,outpatient,,,607.75,303.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG HEMORRHOIDECTOMY EXT >=2,20946250,CDM,983,RC,46250,HCPCS,outpatient,,,1358.5,679.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG HEMORRHOIDECTOMY INT/ EXT SINGLE,20946255,CDM,983,RC,46255,HCPCS,outpatient,,,1820.25,910.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG HEMORRHOIDECTOMY FISSURECTOMY SINGLE,20946257,CDM,983,RC,46257,HCPCS,outpatient,,,1983,991.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG HEMORRHOIDECTOMY INT/EXT 2 OR >,20946260,CDM,983,RC,46260,HCPCS,outpatient,,,1306,653,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG HEMORRHOIDECTOMY FISSURECTOMY 2 OR >,20946261,CDM,983,RC,46261,HCPCS,outpatient,,,2734.25,1367.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG SURGICAL TREATMENT AL FISSURE,20946270,CDM,983,RC,46270,HCPCS,outpatient,,,1268.75,634.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG ANOSCOPY DIAG COLLECTION OF SPECIMEN,20946600,CDM,983,RC,46600,HCPCS,outpatient,,,167,83.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG DESTRUCTION LESION(S) ANUS EXTENSIVE,20946924,CDM,983,RC,46924,HCPCS,outpatient,,,533.25,266.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG CURETTAGE/CAUTERY AL FISSURE INITIA,20946940,CDM,983,RC,46940,HCPCS,outpatient,,,383,191.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG LAPAROSCOPY RESECTION LIVER MASS,20947379,CDM,983,RC,47379,HCPCS,outpatient,,,1106.25,553.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of gallbladder using an endoscope,20947562,CDM,983,RC,47562,HCPCS,outpatient,,,2156.25,1078.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Gallbladder removal with use of an x-ray exam of the bile ducts,20947563,CDM,983,RC,47563,HCPCS,outpatient,,,2217.5,1108.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG CHOLECYSTECTOMY,20947600,CDM,983,RC,47600,HCPCS,outpatient,,,3073.5,1536.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG CHOLECYSTECTOMY W CHOLANGIOGRAPHY,20947605,CDM,983,RC,47605,HCPCS,outpatient,,,2867.75,1433.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXPLORATORY LAPAROTOMY,20949000,CDM,983,RC,49000,HCPCS,outpatient,,,2270.25,1135.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG REOPENING OF RECENT LAPAROTOMY,20949002,CDM,983,RC,49002,HCPCS,outpatient,,,2941,1470.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS DRAIGE PERITONEAL ABSCESS,20949020,CDM,983,RC,49020,HCPCS,outpatient,,,4644.25,2322.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG PARACENTESIS ABDOMIL PARA,20949082,CDM,983,RC,49082,HCPCS,outpatient,,,346.5,173.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS ABDOMIL PARACENTESIS WITH GUIDANCE,20949083,CDM,983,RC,49083,HCPCS,outpatient,,,312,156,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS PERITONEAL LAVAGE,20949084,CDM,983,RC,49084,HCPCS,outpatient,,,318.5,159.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG UMBILECTOMY OMPHALECTOMY EXC OF UMB,20949250,CDM,983,RC,49250,HCPCS,outpatient,,,1738.25,869.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG OMENTECTOMY EPIPLOECTOMY RESECT OMEN,20949255,CDM,983,RC,49255,HCPCS,outpatient,,,2162,1081,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG LAPAROSCOPY ABD PERITONEUM OMEN,20949320,CDM,983,RC,49320,HCPCS,outpatient,,,969.75,484.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG LAP LYSIS ADHESIONS OF OMENTUM,20949329,CDM,983,RC,49329,HCPCS,outpatient,,,2015.5,1007.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG REPLACEMENT GASTROSTOMY OR CECOSTOMY,20949450,CDM,983,RC,49450,HCPCS,outpatient,,,198.75,99.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Repair of groin hernia patient age 5 years or older,20949505,CDM,983,RC,49505,HCPCS,outpatient,,,1500.25,750.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS RPR RECURRENT INGUIL HERNIA RED,20949520,CDM,983,RC,49520,HCPCS,outpatient,,,1839,919.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG RPR INITIAL INCISIOL VENTRAL HERNIA,20949560,CDM,983,RC,49560,HCPCS,outpatient,,,2166,1083,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG RPR INITIAL INCISIOL VENTRAL HERNIA,20949561,CDM,983,RC,49561,HCPCS,outpatient,,,2734.75,1367.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG RPR RECURRENT INCISIOL VENTRAL HERN,20949565,CDM,983,RC,49565,HCPCS,outpatient,,,2238.75,1119.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG IMPLANTATION OF MESH PROSTHESIS OPEN,20949568,CDM,983,RC,49568,HCPCS,outpatient,,,831.25,415.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Repair of umbilical hernia in patients over 5 years old,20949585,CDM,983,RC,49585,HCPCS,outpatient,,,1261.75,630.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS REPAIR UMBILICAL HERNIA 5YR+ INC,20949587,CDM,983,RC,49587,HCPCS,outpatient,,,1503.25,751.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Inguil hernia repair done by laparoscope,20949650,CDM,983,RC,49650,HCPCS,outpatient,,,1242,621,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG LAPAROSCOPY SURG RPR VENTR UMBIL HERN,20949652,CDM,983,RC,49652,HCPCS,outpatient,,,2334.75,1167.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG LAPAR SURG RPR RECURR INCIS HERNIA,20949656,CDM,983,RC,49656,HCPCS,outpatient,,,2449.75,1224.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG LAP SURG RPR REC INC HERN INCAR,20949657,CDM,983,RC,49657,HCPCS,outpatient,,,4008.5,2004.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a small joint/bursa without ultrasound,20950600,CDM,983,RC,20600,HCPCS,outpatient,,,171,85.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG DESTRUCTION LESION PENIS EXTENSIVE,20954065,CDM,983,RC,54065,HCPCS,outpatient,,,436.75,218.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG INCISION AND DRAIGE VULVA PERINEAL,20956405,CDM,983,RC,56405,HCPCS,outpatient,,,442.5,221.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG CLOSURE RECTOVAGIL FISTULA,20957300,CDM,983,RC,57300,HCPCS,outpatient,,,2859.25,1429.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS NEUROPLASTY/TRANS ULR AT WRIST RT,20960719,CDM,983,RC,64719,HCPCS,outpatient,,,2244,1122,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Release of the transverse carpal ligament,20960721,CDM,983,RC,64721,HCPCS,outpatient,,,1187.75,593.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG INJ ANESTHETIC AGT OTH PERIPHERAL NE,20964450,CDM,983,RC,64450,HCPCS,outpatient,,,204,102,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG NEUROPLASTY MAJ PERIPHERAL NERVE OPEN,20964708,CDM,983,RC,64708,HCPCS,outpatient,,,2848.25,1424.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS NEUROPLASTY TRANS ULR NERVE ELB LT,20964718,CDM,983,RC,64718,HCPCS,outpatient,,,1543,771.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS NEUROPLASTY/TRANS ULR AT WRIST LT,20964719,CDM,983,RC,64719,HCPCS,outpatient,,,2244,1122,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Release of the transverse carpal ligament,20964721,CDM,983,RC,64721,HCPCS,outpatient,,,1187.75,593.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG DRAIN EXT EAR ABSCESS HEMATOMA SIMP,20969000,CDM,983,RC,69000,HCPCS,outpatient,,,296.25,148.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG BIOPSY EXTERL EAR,20969100,CDM,983,RC,69100,HCPCS,outpatient,,,124.25,62.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG US UPPER MID ABDOMEN SOFT TISSUE,20976999,CDM,972,RC,76999,HCPCS,outpatient,,,132.5,66.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG FLUOROSCOPIC GUIDANCE PICC PLACEMENT,20977001,CDM,983,RC,77001,HCPCS,outpatient,,,63.25,31.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Release of the transverse carpal ligament,20984721,CDM,983,RC,64721,HCPCS,outpatient,,,1187.75,593.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,20990121,CDM,983,RC,G0121,HCPCS,outpatient,,,1377,688.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG LAPAROSCOPY SURG RPR PARAESOP ASSIST,20993281,CDM,983,RC,43281,HCPCS,outpatient,,,4936.5,2468.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG LAPAROSCOPY WITH IMPLANTATION OF MESH,20993282,CDM,983,RC,43282,HCPCS,outpatient,,,892.5,446.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG LAPAROSCOP SURG GASTRIC RESTRICT ASSI,20993644,CDM,983,RC,43644,HCPCS,outpatient,,,816.25,408.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG LAPAROSCOPY REMOVAL DEVICE/PORT ASSIS,20993774,CDM,983,RC,43774,HCPCS,outpatient,,,397.25,198.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG LAPAROSCOPY LONGITUDIL GASTRECTOMY,20993775,CDM,983,RC,43775,HCPCS,outpatient,,,666.5,333.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG ILEOSTOMY OR JEJUNOSTOMY NONTUBE,20994310,CDM,983,RC,44310,HCPCS,outpatient,,,3465.25,1732.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION SKIN/SUBQ ABDOMEN ASSIST,20995830,CDM,983,RC,15830,HCPCS,outpatient,,,494.5,247.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG EXCISION EXCESS SKIN SUBQ ABD ASSIST,20995847,CDM,983,RC,15847,HCPCS,outpatient,,,246.25,123.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG CLOSURE RECTOVAGIL FISTULA ASSIST,20997300,CDM,983,RC,57300,HCPCS,outpatient,,,2859.25,1429.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Debridement (for example, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps)",20997597,CDM,983,RC,97597,HCPCS,outpatient,,,126.25,63.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG DEBRIDMT EPT/DERMIS EA ADDTL 20 SQCM,20997598,CDM,983,RC,97598,HCPCS,outpatient,,,180.5,90.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG WOUND VAC 50  SQ CM OR LESS,20997605,CDM,983,RC,97605,HCPCS,outpatient,,,81.75,40.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS SUPRACERVICAL ABD HYSTERECTOMY ASSIST,20998180,CDM,983,RC,58180,HCPCS,outpatient,,,412.25,206.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG GLOBAL,20999024,CDM,969,RC,99024,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 10 minutes",20999202,CDM,983,RC,99202,HCPCS,outpatient,,,107,53.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 30 min",20999203,CDM,983,RC,99203,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 45 min",20999204,CDM,983,RC,99204,HCPCS,outpatient,,,257,128.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 60 min",20999205,CDM,983,RC,99205,HCPCS,outpatient,,,343.5,171.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient not requiring a physician,20999211,CDM,983,RC,99211,HCPCS,outpatient,,,24.5,12.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient requiring a physician,20999212,CDM,983,RC,99212,HCPCS,outpatient,,,56.5,28.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",20999213,CDM,983,RC,99213,HCPCS,outpatient,,,106.25,53.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 25 minutes",20999214,CDM,983,RC,99214,HCPCS,outpatient,,,162,81,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient, visit typically 40 minutes",20999215,CDM,983,RC,99215,HCPCS,outpatient,,,228.75,114.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG OBSERVATION DISCHARGE,20999217,CDM,983,RC,99217,HCPCS,outpatient,,,173.5,86.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG OBSERVATION CARE INITIAL LOW,20999218,CDM,983,RC,99218,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG OBSERVATION CARE INITIAL MODERATE,20999219,CDM,983,RC,99219,HCPCS,outpatient,,,263,131.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG OBSERVATION CARE INITIAL HIGH,20999220,CDM,983,RC,99220,HCPCS,outpatient,,,377.5,188.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG INITIAL HOSPITAL CARE LOW,20999221,CDM,987,RC,99221,HCPCS,outpatient,,,234.25,117.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG INITIAL HOSPITAL CARE MODERATE,20999222,CDM,987,RC,99222,HCPCS,outpatient,,,318.5,159.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG INITIAL HOSPITAL CARE HIGH,20999223,CDM,987,RC,99223,HCPCS,outpatient,,,465.25,232.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG SUB OV CARE MOD COMP,20999225,CDM,982,RC,99225,HCPCS,outpatient,,,137,68.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG SUBSEQ OBS CARE HIGH COMPLEXIT,20999226,CDM,987,RC,99226,HCPCS,outpatient,,,203,101.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG SUBSEQUENT IP HOSPITAL CARE LOW,20999231,CDM,987,RC,99231,HCPCS,outpatient,,,99,49.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG SUBSEQUENT IP HOSPITAL CARE MODERATE,20999232,CDM,987,RC,99232,HCPCS,outpatient,,,169.5,84.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG SUBSEQUENT IP HOSPITAL CARE HIGH,20999233,CDM,987,RC,99233,HCPCS,outpatient,,,248.25,124.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG OBS IP ADMIT DISC SAME DAY LOW,20999234,CDM,987,RC,99234,HCPCS,outpatient,,,329.75,164.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG OBS IP ADMIT DISC SAME DAY MODERATE,20999235,CDM,987,RC,99235,HCPCS,outpatient,,,432,216,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG OBS IP ADMIT DISC SAME DAY HIGH,20999236,CDM,987,RC,99236,HCPCS,outpatient,,,542.25,271.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG HOSPITAL DISCHARGE DAY MGMT < 30 MIN,20999238,CDM,987,RC,99238,HCPCS,outpatient,,,172.25,86.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG HOSPITAL DISCHARGE DAY MGMT > 30 MIN,20999239,CDM,987,RC,99239,HCPCS,outpatient,,,248.75,124.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG ER PT LEVEL 1,20999281,CDM,981,RC,99281,HCPCS,outpatient,,,54.5,27.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG ER PT LEVEL 2,20999282,CDM,981,RC,99282,HCPCS,outpatient,,,106.5,53.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, moderately severe problem",20999283,CDM,981,RC,99283,HCPCS,outpatient,,,164.75,82.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem of high severity",20999284,CDM,981,RC,99284,HCPCS,outpatient,,,298.75,149.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem with significant threat to life or function",20999285,CDM,981,RC,99285,HCPCS,outpatient,,,458.25,229.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG CRITICAL CARE 1ST HOUR,20999291,CDM,987,RC,99291,HCPCS,outpatient,,,641.75,320.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG INIT NURSING FACILITY CARE LOW,20999304,CDM,983,RC,99304,HCPCS,outpatient,,,208,104,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG SUBSEQUENT NRSG FAC PROB FOCUSED,20999307,CDM,983,RC,99307,HCPCS,outpatient,,,105,52.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG SUBS NURS FAC LOW,20999308,CDM,983,RC,99308,HCPCS,outpatient,,,157.5,78.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG NURS FAC SUB CARE HIGH COMPLEX,20999310,CDM,983,RC,99310,HCPCS,outpatient,,,310.5,155.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG RPR INITIAL INCISIOL VENTRAL HERNIA,20999560,CDM,983,RC,49560,HCPCS,outpatient,,,306,153,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Colorectal cancer screening; colonoscopy on individual at high risk,20999999,CDM,983,RC,G0105,HCPCS,outpatient,,,1377,688.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
PN COUNSELING LUNG CA SCREENING (LDCT),21000296,CDM,983,RC,G0296,HCPCS,outpatient,,,49.75,24.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CP TH MEDICAL DISCUSSION 5-10 MIN,21002012,CDM,982,RC,G2012,HCPCS,outpatient,,,33.5,16.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 5-10 minutes of medical discussion",21008441,CDM,983,RC,99441,HCPCS,outpatient,,,58.75,29.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 11-20 minutes of medical discussion",21008442,CDM,983,RC,99442,HCPCS,outpatient,,,106.75,53.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 21-30 minutes of medical discussion",21008443,CDM,983,RC,99443,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 10 minutes",21008902,CDM,983,RC,99202,HCPCS,outpatient,,,107,53.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 30 min",21008903,CDM,983,RC,99203,HCPCS,outpatient,,,161.75,80.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 45 min",21008904,CDM,983,RC,99204,HCPCS,outpatient,,,268.75,134.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 60 min",21008905,CDM,983,RC,99205,HCPCS,outpatient,,,349.5,174.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient not requiring a physician,21008911,CDM,983,RC,99211,HCPCS,outpatient,,,24.5,12.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient requiring a physician,21008912,CDM,983,RC,99212,HCPCS,outpatient,,,56.5,28.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",21008913,CDM,983,RC,99213,HCPCS,outpatient,,,106.25,53.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 25 minutes",21008914,CDM,983,RC,99214,HCPCS,outpatient,,,163.25,81.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient, visit typically 40 minutes",21008915,CDM,983,RC,99215,HCPCS,outpatient,,,231.75,115.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ER SCREEN MINIMAL,21009281,CDM,981,RC,99281,HCPCS,outpatient,,,120.5,60.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ER PAT /LOW,21009282,CDM,981,RC,99282,HCPCS,outpatient,,,183.75,91.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, moderately severe problem",21009283,CDM,981,RC,99283,HCPCS,outpatient,,,166,83,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem of high severity",21009284,CDM,981,RC,99284,HCPCS,outpatient,,,307.75,153.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem with significant threat to life or function",21009285,CDM,981,RC,99285,HCPCS,outpatient,,,458.25,229.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Test to determine how well oxygen moves from the lungs to the blood stream,21094010,CDM,983,RC,94010,HCPCS,outpatient,,,21.25,10.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Test to determine if wheezing is present,21094060,CDM,983,RC,94060,HCPCS,outpatient,,,37.5,18.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
BRONCHOSPASM PROV EVAL MULT,21094070,CDM,983,RC,94070,HCPCS,outpatient,,,72.25,36.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MVV,21094200,CDM,983,RC,94200,HCPCS,outpatient,,,14.25,7.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Graphical representation of inspiration and expiration,21094375,CDM,983,RC,94375,HCPCS,outpatient,,,37.5,18.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
PULMORY STRESS TEST SIMPLE 6 MIN WALK,21094620,CDM,983,RC,94618,HCPCS,outpatient,,,64.75,32.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INHALATION TRT W AEROSOL MED,21094664,CDM,983,RC,94664,HCPCS,outpatient,,,34.5,17.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Measures how much air is in the lungs after taking a deep breath,21094726,CDM,983,RC,94726,HCPCS,outpatient,,,27.25,13.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Measure of lung function and gas exchange,21094727,CDM,983,RC,94727,HCPCS,outpatient,,,39.5,19.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Test to measure how well gases diffuse across lung surfaces,21094729,CDM,983,RC,94729,HCPCS,outpatient,,,174.75,87.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
POLYSOMNOGRAPHY <6 YRS > 4 PAR ATTENDED,21095782,CDM,983,RC,95782,HCPCS,outpatient,,,401,200.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
POLYSOM < 6 YRS CPAP/BIL VL,21095783,CDM,985,RC,95783,HCPCS,outpatient,,,439,219.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SLEEP STUDY UTTEND,21095800,CDM,985,RC,95800,HCPCS,outpatient,,,174.25,87.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SLEEP STUDY UTTEND MINIMUM,21095801,CDM,985,RC,95801,HCPCS,outpatient,,,155.25,77.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
EEG EXTENDED 41-60 MIN,21095812,CDM,983,RC,95812,HCPCS,outpatient,,,174.75,87.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
EEG EXTENDED > 1 HR,21095813,CDM,983,RC,95813,HCPCS,outpatient,,,279.5,139.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
EEG AWAKE AND DROWSY,21095816,CDM,983,RC,95816,HCPCS,outpatient,,,177,88.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
EEG AWAKE AND ASLEEP,21095819,CDM,983,RC,95819,HCPCS,outpatient,,,105.75,52.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
EEG CEREBRAL DEATH EVAL ONLY,21095824,CDM,983,RC,95824,HCPCS,outpatient,,,123.75,61.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 10 minutes",21099202,CDM,983,RC,99202,HCPCS,outpatient,,,107,53.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 30 min",21099203,CDM,983,RC,99203,HCPCS,outpatient,,,161.75,80.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 45 min",21099204,CDM,983,RC,99204,HCPCS,outpatient,,,268.75,134.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 60 min",21099205,CDM,983,RC,99205,HCPCS,outpatient,,,349.5,174.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient not requiring a physician,21099211,CDM,983,RC,99211,HCPCS,outpatient,,,24.5,12.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient requiring a physician,21099212,CDM,983,RC,99212,HCPCS,outpatient,,,54.75,27.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",21099213,CDM,983,RC,99213,HCPCS,outpatient,,,105.75,52.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 25 minutes",21099214,CDM,983,RC,99214,HCPCS,outpatient,,,163.25,81.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient, visit typically 40 minutes",21099215,CDM,983,RC,99215,HCPCS,outpatient,,,231.75,115.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INITIAL HOSPITAL CARE LOW,21099221,CDM,987,RC,99221,HCPCS,outpatient,,,234.25,117.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INITIAL HOSPITAL CARE MODERATE,21099222,CDM,987,RC,99222,HCPCS,outpatient,,,318.5,159.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SUBSEQ HOSPITAL 1,21099231,CDM,987,RC,99231,HCPCS,outpatient,,,98.25,49.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SUBSEQ HOSPITAL 2,21099232,CDM,987,RC,99232,HCPCS,outpatient,,,176.25,88.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SUBSEQ HOSPITAL 3,21099233,CDM,987,RC,99233,HCPCS,outpatient,,,252,126,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CONSULT OFFICE 2,21099242,CDM,983,RC,99242,HCPCS,outpatient,,,217.5,108.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ER SCREEN MINIMAL,21099281,CDM,981,RC,99281,HCPCS,outpatient,,,54.5,27.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ER PAT /LOW,21099282,CDM,981,RC,99282,HCPCS,outpatient,,,106,53,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, moderately severe problem",21099283,CDM,981,RC,99283,HCPCS,outpatient,,,166,83,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem of high severity",21099284,CDM,981,RC,99284,HCPCS,outpatient,,,307.75,153.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem with significant threat to life or function",21099285,CDM,981,RC,99285,HCPCS,outpatient,,,458.25,229.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INITIAL NURSING FACILITY CARE,21099304,CDM,983,RC,99304,HCPCS,outpatient,,,210.25,105.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INIT NURSING FACILITY CARE PER DAY MODER,21099305,CDM,983,RC,99305,HCPCS,outpatient,,,289.25,144.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SUBSEQUENT NRSG FAC PROB FOCUSED,21099307,CDM,983,RC,99307,HCPCS,outpatient,,,105,52.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
PN SUBS NRSING FACILITY CARE PER DAY MOD,21099309,CDM,983,RC,99309,HCPCS,outpatient,,,208.25,104.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SMOKING CESSATION COUNSELING 3 TO 10 MIN,21099406,CDM,983,RC,99406,HCPCS,outpatient,,,27.25,13.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SMOKING CESSATION COUNSELING OVER 10 MIN,21099407,CDM,983,RC,99407,HCPCS,outpatient,,,54.5,27.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN GLOBAL-OTHER THAN PMH,23500024,CDM,969,RC,99024,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN COUNSELING LUNG CANCER SCREEN LDCT,23500296,CDM,983,RC,G0296,HCPCS,outpatient,,,49.75,24.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN GLOBAL FOR OTHER PROVIDER,23500924,CDM,969,RC,99024,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN TH MEDICAL DISCUSSION 5-10 MIN,23502012,CDM,982,RC,G2012,HCPCS,outpatient,,,33.5,16.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN EXCISION SKIN/SUBQ ABDOMEN ASSIST,23505830,CDM,983,RC,15830,HCPCS,outpatient,,,509.5,254.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 5-10 minutes of medical discussion",23508441,CDM,983,RC,99441,HCPCS,outpatient,,,58.75,29.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 11-20 minutes of medical discussion",23508442,CDM,983,RC,99442,HCPCS,outpatient,,,106.75,53.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 21-30 minutes of medical discussion",23508443,CDM,983,RC,99443,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 10 minutes",23508902,CDM,983,RC,99202,HCPCS,outpatient,,,107,53.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 30 min",23508903,CDM,983,RC,99203,HCPCS,outpatient,,,161.75,80.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 45 min",23508904,CDM,983,RC,99204,HCPCS,outpatient,,,268.75,134.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 60 min",23508905,CDM,983,RC,99205,HCPCS,outpatient,,,349.5,174.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient not requiring a physician,23508911,CDM,983,RC,99211,HCPCS,outpatient,,,24.5,12.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient requiring a physician,23508912,CDM,983,RC,99212,HCPCS,outpatient,,,56.5,28.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",23508913,CDM,983,RC,99213,HCPCS,outpatient,,,106.25,53.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 25 minutes",23508914,CDM,983,RC,99214,HCPCS,outpatient,,,163.25,81.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient, visit typically 40 minutes",23508915,CDM,983,RC,99215,HCPCS,outpatient,,,231.75,115.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN EXCISION SKIN/SUBQ ABDOMEN,23509329,CDM,983,RC,49329,HCPCS,outpatient,,,1009.75,504.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Fine Needle Aspiration Biopsy without imaging,23510021,CDM,983,RC,10021,HCPCS,outpatient,,,208.5,104.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Incision and draige of abscess; simple or single and complex or multiple,23510060,CDM,983,RC,10060,HCPCS,outpatient,,,239.25,119.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN INC DRAIN ABSCESS MULTIPLE,23510061,CDM,983,RC,10061,HCPCS,outpatient,,,430,215,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Incision and draige of hematoma, seroma or fluid collection",23510140,CDM,983,RC,10140,HCPCS,outpatient,,,309,154.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Puncture aspiration of abscess, hematoma, bulla, or cyst",23510160,CDM,983,RC,10160,HCPCS,outpatient,,,247.5,123.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN INC DRAIN COMPLEX POSTOP WOUND IN,23510180,CDM,983,RC,10180,HCPCS,outpatient,,,458.75,229.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN DEBRIDEMENT SKIN TO FASCIA NECROT IN,23511005,CDM,983,RC,11005,HCPCS,outpatient,,,191.75,95.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN DEBRIDEMENT SKIN SUBCUT TISSUE,23511042,CDM,983,RC,11042,HCPCS,outpatient,,,135.25,67.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"GYN DEBRIDEMENT SKIN, SUBCU MUSCLE",23511043,CDM,983,RC,11043,HCPCS,outpatient,,,602.5,301.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN DEBRIDMT SUBQ E/ADDTL 20 SQCM,23511045,CDM,983,RC,11045,HCPCS,outpatient,,,45.25,22.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN DEBRIDEMENT MUSCLE EA ADDTL 20 SQ CM,23511046,CDM,983,RC,11046,HCPCS,outpatient,,,90.75,45.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN PARING CUTTING BEN HYPERKERATOTIC LE,23511055,CDM,983,RC,11055,HCPCS,outpatient,,,69.5,34.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Paring or cutting of benign hyperkeratotic lesion,23511056,CDM,983,RC,11056,HCPCS,outpatient,,,94.75,47.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN PARING CUT BEN HYPERKER LES > 4,23511057,CDM,983,RC,11057,HCPCS,outpatient,,,123.75,61.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN PUNCH BX SKIN SINGLE LESION,23511104,CDM,983,RC,11104,HCPCS,outpatient,,,118.25,59.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Removal of skin tags, multiple fibrocutaneous tags, any area",23511200,CDM,983,RC,11200,HCPCS,outpatient,,,169.75,84.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN REMOVAL SKIN TAGS EA ADDTL 10 OR PAR,23511201,CDM,983,RC,11201,HCPCS,outpatient,,,48.75,24.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN SHAVE EPID DERMAL LES SINGLE <.5 C,23511300,CDM,983,RC,11300,HCPCS,outpatient,,,82.25,41.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN SHAVE EPID DERMAL LES SINGLE .6 TO 1,23511301,CDM,983,RC,11301,HCPCS,outpatient,,,135.25,67.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN SHAVE EPID DERMAL LES SINGLE 1.1-2.0,23511302,CDM,983,RC,11302,HCPCS,outpatient,,,167,83.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN SHAVE EPID DERMAL LES SINGLE <.5 CM,23511305,CDM,983,RC,11305,HCPCS,outpatient,,,105.25,52.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN SHAVING EPIDERMAL OR DERMA LESION .6,23511306,CDM,983,RC,11306,HCPCS,outpatient,,,154.25,77.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN SHAVING EPIDERMA/DERM LESION 0.5CM<,23511310,CDM,983,RC,11310,HCPCS,outpatient,,,125.25,62.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN EXCISION BEN .5 CM OR LESS,23511400,CDM,983,RC,11400,HCPCS,outpatient,,,187,93.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Under Excision-Benign Lesions Procedures on the Skin 0.6-1 CM,23511401,CDM,983,RC,11401,HCPCS,outpatient,,,250.5,125.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN EXCISION BEN 1.1 TO 2.0 CM,23511402,CDM,983,RC,11402,HCPCS,outpatient,,,278.75,139.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN EXCISION BEN 2.1 TO 3.0 CM,23511403,CDM,983,RC,11403,HCPCS,outpatient,,,354.75,177.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN EXCISION BEN 3.1 TO 4.0 CM,23511404,CDM,983,RC,11404,HCPCS,outpatient,,,395.75,197.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN EXCISION BEN > 4.0 CM,23511406,CDM,983,RC,11406,HCPCS,outpatient,,,596.75,298.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN EXCISION BEN <.5 CM,23511420,CDM,983,RC,11420,HCPCS,outpatient,,,205,102.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN EXCISION BEN .6 TO 1.0 CM,23511421,CDM,983,RC,11421,HCPCS,outpatient,,,278,139,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Under Excision-Benign Lesions Procedures on the Skin 1.1-2 CM,23511422,CDM,983,RC,11422,HCPCS,outpatient,,,334,167,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN EXCISION BEN 2.1 TO 3.0 CM,23511423,CDM,983,RC,11423,HCPCS,outpatient,,,391.25,195.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN EXCISION BEN 3.1 TO 4.0 CM,23511424,CDM,983,RC,11424,HCPCS,outpatient,,,453.75,226.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN EXC BENIGN LESION >4.0 CM SCALP NECK,23511426,CDM,983,RC,11426,HCPCS,outpatient,,,760,380,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN EXCISION BEN LESION <.5 CM,23511440,CDM,983,RC,11440,HCPCS,outpatient,,,240,120,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN EXCISION SKIN & SUBC HID PERI ING SI,23511470,CDM,983,RC,11470,HCPCS,outpatient,,,676.25,338.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN EXCISION MALIG 1.1 TO 2.0 CM,23511622,CDM,983,RC,11622,HCPCS,outpatient,,,424.75,212.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN EXCISION BEN 3.1 TO 4.0 CM,23511624,CDM,983,RC,11424,HCPCS,outpatient,,,554.25,277.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Injections to remove up to 7 lesions on the skin,23511900,CDM,983,RC,11900,HCPCS,outpatient,,,83.75,41.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN INSERTION NONBIODEGRADABLE DRUG IMPL,23511981,CDM,983,RC,11981,HCPCS,outpatient,,,261.25,130.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN REMOVAL NONBIODEGRADABLE DRUG DELIVE,23511982,CDM,983,RC,11982,HCPCS,outpatient,,,275.5,137.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN REMOVAL/INSERT NONBIODEGR DRUG IMPLA,23511983,CDM,983,RC,11983,HCPCS,outpatient,,,538.5,269.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GS LAYER CLOSE WOUNDS < 2.5 CM,23512031,CDM,983,RC,12031,HCPCS,outpatient,,,400.5,200.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN LAYER CLOSE WOUNDS 2.6 TO 7.5 CM,23512032,CDM,983,RC,12032,HCPCS,outpatient,,,485.25,242.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN LAYER CLOSE WOUNDS 7.6 TO 12.5 CM,23512034,CDM,983,RC,12034,HCPCS,outpatient,,,518.25,259.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
SG LAYER CLOSE WOUNDS 12.6 TO 20.0 CM,23512035,CDM,983,RC,12035,HCPCS,outpatient,,,618.5,309.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN LAYER CLOSE WOUNDS 20.1 TO 30.0,23512036,CDM,983,RC,12036,HCPCS,outpatient,,,780.75,390.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN LAYER CLOSE WOUNDS 2.6 TO 7.5 CM,23512042,CDM,983,RC,12042,HCPCS,outpatient,,,386.75,193.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN SECONDARY CLOSURE SURGICAL,23513160,CDM,983,RC,13160,HCPCS,outpatient,,,2366.5,1183.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN EXCISION SKIN/SUBQ ABDOMEN,23515830,CDM,983,RC,15830,HCPCS,outpatient,,,2533,1266.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN EXCISION EXCESS SKIN SUBQ ABDOMEN TI,23515847,CDM,983,RC,15847,HCPCS,outpatient,,,1228.75,614.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN SUCTION ASSISTED LIPECTOMY TRUNK,23515877,CDM,983,RC,15877,HCPCS,outpatient,,,2769.5,1384.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN DRESS AND OR  DEBRIDE < 5%,23516020,CDM,983,RC,16020,HCPCS,outpatient,,,108.25,54.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of pre-cancerous lesion,23517000,CDM,983,RC,17000,HCPCS,outpatient,,,136,68,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of 2-14 pre-cancerous lesions,23517003,CDM,983,RC,17003,HCPCS,outpatient,,,16.25,8.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN DESTRUCTION 15 OR MORE LESIONS,23517004,CDM,983,RC,17004,HCPCS,outpatient,,,343.5,171.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of 1-14 common or plantar warts,23517110,CDM,983,RC,17110,HCPCS,outpatient,,,167.75,83.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Chemical destruction of pre-cancerous lesions of the skin,23517250,CDM,983,RC,17250,HCPCS,outpatient,,,98.75,49.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN PANNICULECTOMY,23517999,CDM,983,RC,17999,HCPCS,outpatient,,,2043.5,1021.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN US CYST ASP BREAST RT,23519000,CDM,983,RC,19000,HCPCS,outpatient,,,131.75,65.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN PUNCTURE ASPIR CYST BREAST EA ADD,23519001,CDM,983,RC,19001,HCPCS,outpatient,,,67,33.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN NEEDLE CORE BREAST BX WO IMAG,23519100,CDM,983,RC,19100,HCPCS,outpatient,,,195.75,97.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN BIOPSY OF BREAST OPEN INCISIOL,23519101,CDM,983,RC,19101,HCPCS,outpatient,,,561.5,280.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
REMOVAL OF BREAST LESION,23519120,CDM,983,RC,19120,HCPCS,outpatient,,,1023.75,511.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN TRIGGER PT INJ MUSC 1-2,23520552,CDM,983,RC,20552,HCPCS,outpatient,,,102.75,51.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN EXCISION TUMOR SOFT TISSUE OF BACK F,23521930,CDM,983,RC,21930,HCPCS,outpatient,,,963,481.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN EXCISION TUMOR SOFT TIS ABD WALL 3 C,23522903,CDM,983,RC,22903,HCPCS,outpatient,,,1219.75,609.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN I&D PELVIS HIP JT; DEEP ABSCESS HEMA,23526990,CDM,983,RC,26990,HCPCS,outpatient,,,1846,923,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN EXPLORE POSTOP HEMM ABDOMEN,23535840,CDM,960,RC,35840,HCPCS,outpatient,,,2015.25,1007.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN POSTOP BLEEDING REPAIR,23537799,CDM,983,RC,37799,HCPCS,outpatient,,,361.75,180.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYNLTD LYMPHADENECTOMY PELVIC PARAAORTIC,23538562,CDM,983,RC,38562,HCPCS,outpatient,,,2155.25,1077.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN LAPARO SURG RETRIOPERITONEAL LYMPH,23538570,CDM,983,RC,38570,HCPCS,outpatient,,,1769,884.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN LAPARO SURG BIL PELVIC LYMPH,23538571,CDM,983,RC,38571,HCPCS,outpatient,,,2720,1360,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN PELVIC LYMPH INC EXT ILIAC HYPOGASTR,23538770,CDM,983,RC,38770,HCPCS,outpatient,,,2653.25,1326.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN ENTEROLYSIS,23544005,CDM,960,RC,44005,HCPCS,outpatient,,,3328.25,1664.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN ENTERECTOMY RESECTION OF SMALL INTES,23544120,CDM,983,RC,44120,HCPCS,outpatient,,,3692,1846,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN COLECTOMY PARTIAL W ASTOMOSIS,23544143,CDM,983,RC,44143,HCPCS,outpatient,,,5015.5,2507.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN COLECTOMY PARTIAL W ASTOMOSI,23544145,CDM,983,RC,44145,HCPCS,outpatient,,,5100.25,2550.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN LAPAROSCOPY SURGICAL ENTEROLYSIS,23544180,CDM,983,RC,44180,HCPCS,outpatient,,,2810,1405,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN LAPRO COLOSTOMY OR SKIN LEVEL CECOST,23544188,CDM,983,RC,44188,HCPCS,outpatient,,,2776,1388,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN LAP COLECTOMY TOTAL ABD W ILEOSTOMY,23544210,CDM,983,RC,44210,HCPCS,outpatient,,,5257.75,2628.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN SUTURE SMALL INTESTINE FOR PERFORATE,23544602,CDM,983,RC,44602,HCPCS,outpatient,,,4167.5,2083.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN EXCISION MECKELS DIVERTICULUM,23544800,CDM,983,RC,44800,HCPCS,outpatient,,,2290.75,1145.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN APPENDECTOMY,23544950,CDM,983,RC,44950,HCPCS,outpatient,,,1952.75,976.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN APPENDECTOMY SECONDARY PROC,23544955,CDM,983,RC,44955,HCPCS,outpatient,,,263.5,131.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN  APPENDECTOMY RUPTURED ABSCES,23544960,CDM,983,RC,44960,HCPCS,outpatient,,,2619.5,1309.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN LAPROSCOPY SURGICAL APPENDECTOM,23544970,CDM,983,RC,44970,HCPCS,outpatient,,,1783.25,891.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN LAP APPENDECTOMY AT TIME OF MAJ PROC,23544979,CDM,983,RC,44979,HCPCS,outpatient,,,891.75,445.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN BIOP ANORECTAL WALL; AL APPROACH,23545100,CDM,983,RC,45100,HCPCS,outpatient,,,846.75,423.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN ANORECTAL MYOMECTOMY,23545108,CDM,983,RC,45108,HCPCS,outpatient,,,1037.75,518.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN PAPILLECTOMY OR EXCISION SNGL TAG,23546220,CDM,983,RC,46220,HCPCS,outpatient,,,515.25,257.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN EXCISION EXT HEMORRHOID,23546230,CDM,983,RC,46230,HCPCS,outpatient,,,610,305,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN SURGICAL TREATMENT AL FISSURE,23546270,CDM,983,RC,46270,HCPCS,outpatient,,,1285.5,642.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN ANOSCOPY DIAG COLLECTION OF SPECIMEN,23546600,CDM,983,RC,46600,HCPCS,outpatient,,,162,81,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"GYN ANOSCOPY W REM SGLE TUMOR, POLYP LES",23546610,CDM,983,RC,46610,HCPCS,outpatient,,,578.25,289.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"GYN ANOSCOPY W REM MULT TUMOR, POLYP LES",23546612,CDM,983,RC,46612,HCPCS,outpatient,,,701.5,350.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN DESTRUCT LESION ANUS SIMPLE; CHEMICA,23546900,CDM,983,RC,46900,HCPCS,outpatient,,,615,307.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN DESTRUCT LESION ANUS SIMPLE; CYROSUR,23546916,CDM,983,RC,46916,HCPCS,outpatient,,,626.75,313.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN DESTRUCT LESION ANUS SIMPLE; LASER S,23546917,CDM,983,RC,46917,HCPCS,outpatient,,,1167,583.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN DESTRUCT LESION ANUS SIMPLE SURG INC,23546922,CDM,983,RC,46922,HCPCS,outpatient,,,667.75,333.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN DESTRUCT LESION ANUS EXTENSIVE,23546924,CDM,983,RC,46924,HCPCS,outpatient,,,1337.25,668.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN BIOPSY OF LIVER WEDGE,23547100,CDM,983,RC,47100,HCPCS,outpatient,,,2487,1243.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN EXPLORATORY LAPAROTOMY CELIOTOMY BIO,23549000,CDM,983,RC,49000,HCPCS,outpatient,,,2344,1172,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN EXPLORATION RETROPERITONEAL AREA W,23549010,CDM,983,RC,49010,HCPCS,outpatient,,,2877.75,1438.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN DRAIGE OF PERITONEAL ABSCESS OR LO,23549020,CDM,983,RC,49020,HCPCS,outpatient,,,4794.25,2397.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN REOPENING OF RECENT LAPAROTOMY,23549022,CDM,983,RC,49000,HCPCS,outpatient,,,3035.5,1517.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN BIOPSY ABDOMIL OR RETROPERITONEAL,23549180,CDM,983,RC,49180,HCPCS,outpatient,,,364.25,182.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN EXCISION OF PRESACRAL OR SACROCOCCYG,23549215,CDM,983,RC,49215,HCPCS,outpatient,,,6763.5,3381.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN UMBILECTOMY OMPHALECTOMY EXCISON OF,23549250,CDM,983,RC,49250,HCPCS,outpatient,,,1738.25,869.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN OMENTECTOMY EPIPLOECTOMY RESECT OMEN,23549255,CDM,983,RC,49255,HCPCS,outpatient,,,2360.5,1180.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN LAPAROSCOPY ABDOMEN PERITONEUM OMEN,23549320,CDM,983,RC,49320,HCPCS,outpatient,,,1001,500.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN LAPAROSCOPY SURG W BIOPSY SGLE MULTI,23549321,CDM,983,RC,49321,HCPCS,outpatient,,,1055,527.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN LAPAROSCOPY SURG W ASPIRATION OF CAV,23549322,CDM,983,RC,49322,HCPCS,outpatient,,,1144,572,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN LAPAROSCOPY SURG W DRAIGE OF LYMPH,23549323,CDM,983,RC,49323,HCPCS,outpatient,,,1938.25,969.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN LAP LYSIS ADHESIONS OF OMENTUM,23549329,CDM,983,RC,49329,HCPCS,outpatient,,,1953.5,976.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN IMAGE GUIDED FLUID COLLECTION PERITO,23549406,CDM,983,RC,49406,HCPCS,outpatient,,,426.5,213.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN REPAIR INITIAL FEMORAL HERNIA  REDUC,23549550,CDM,983,RC,49550,HCPCS,outpatient,,,1721.25,860.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN REPAIR INITIAL INCISIOL VENTRAL HE,23549560,CDM,983,RC,49560,HCPCS,outpatient,,,2235.75,1117.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN REPAIR RECURRENT INCISIOL VERNTRAL,23549565,CDM,983,RC,49565,HCPCS,outpatient,,,2313,1156.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Repair of umbilical hernia in patients over 5 years old,23549585,CDM,983,RC,49585,HCPCS,outpatient,,,1303.25,651.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN REPAIR SPIGELIAN HERNIA,23549590,CDM,983,RC,49590,HCPCS,outpatient,,,1707.25,853.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN REL ENDOSCOPY EST NEPHROSTOMY OR P,23550553,CDM,983,RC,50553,HCPCS,outpatient,,,1282.25,641.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN URETEROLYSIS W WO REPOSITIONING URE,23550715,CDM,983,RC,50715,HCPCS,outpatient,,,3800,1900,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN URETERONEOCYSTOSTOMY; ASTOMOSIS SG,23550780,CDM,983,RC,50780,HCPCS,outpatient,,,3709.25,1854.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN CYSTOSTOMY; CYSTOTOMY WITH DRAIGE,23551040,CDM,983,RC,51040,HCPCS,outpatient,,,965,482.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN CYSTOSTOMY W INSERT URETERAL CATH,23551045,CDM,983,RC,51045,HCPCS,outpatient,,,1549.25,774.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN CYSTOTOMY FOR EXCISION INCISION OR R,23551535,CDM,983,RC,51535,HCPCS,outpatient,,,2655.75,1327.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"GYN BLADDER IRRIGATION, SPL LAVAGE A/O I",23551700,CDM,983,RC,51700,HCPCS,outpatient,,,83.25,41.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN INSERT NON-INDWELLING BLADDER CATH,23551701,CDM,983,RC,51701,HCPCS,outpatient,,,191.75,95.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN ENDOSCOPIC INJ OF IMPLANT MATERIAL,23551715,CDM,983,RC,51715,HCPCS,outpatient,,,592.5,296.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN SIMPLE CMG PRO FEE ONLY,23551725,CDM,983,RC,51725,HCPCS,outpatient,,,268.25,134.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN COMPLEX CMG PRO FEE ONLY,23551726,CDM,983,RC,51726,HCPCS,outpatient,,,305.5,152.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN COMPLEX CMG W URETH PROF PRO FEE ONL,23551727,CDM,983,RC,51727,HCPCS,outpatient,,,358.75,179.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN COMPLEX CMG W VOIDING PR PRO FEE ONL,23551728,CDM,983,RC,51728,HCPCS,outpatient,,,353.75,176.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN COMPLEX CMG W VOIDING URETH PRES PRO,23551729,CDM,983,RC,51729,HCPCS,outpatient,,,417,208.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
A diagnostic test used to measure the flow of urine,23551741,CDM,983,RC,51741,HCPCS,outpatient,,,205.25,102.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN VOID PRESS INTRA ABD ADD ON CODE PRO,23551797,CDM,983,RC,51797,HCPCS,outpatient,,,161,80.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Ultrasound of bladder to measure urine capacity,23551798,CDM,983,RC,51798,HCPCS,outpatient,,,374,187,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN ANTERIOR VESICOURETHROPEXY SIMPLE,23551840,CDM,983,RC,51840,HCPCS,outpatient,,,2176.25,1088.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN ANTERIOR VESICOURETHROPEXY COMP,23551841,CDM,983,RC,51841,HCPCS,outpatient,,,2585.75,1292.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN ABDOMINO-VAGIL VESICAL NECK SUS,23551845,CDM,983,RC,51845,HCPCS,outpatient,,,1964,982,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN CYSTORRHAPHY SUTURE BLADDER WOUND IN,23551860,CDM,983,RC,51860,HCPCS,outpatient,,,2266.5,1133.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN CLOSURE VESICOVAGIL FISTULA  ABD,23551900,CDM,983,RC,51900,HCPCS,outpatient,,,2773,1386.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN LAPARO SURG URETHRAL SUSPEN STRESS I,23551990,CDM,983,RC,51990,HCPCS,outpatient,,,2617,1308.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN LAPARO SURG SLING OP FOR STRESS INCO,23551992,CDM,983,RC,51992,HCPCS,outpatient,,,2749.25,1374.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Procedure on the bladder,23552000,CDM,983,RC,52000,HCPCS,outpatient,,,275.75,137.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN CYSTOURETHROSCOPY W CALIB,23552281,CDM,983,RC,52281,HCPCS,outpatient,,,1093,546.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Ureteral stents inserted interlly between the bladder and the kidney and will remain within the patient for a defined period of time,23552332,CDM,983,RC,52332,HCPCS,outpatient,,,521.5,260.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN URETHROLYSIS TRANSVAGIL SECONDARY,23553500,CDM,983,RC,53500,HCPCS,outpatient,,,2327.25,1163.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN DILATION OF FEMALE URETHA INC,23553660,CDM,983,RC,53660,HCPCS,outpatient,,,139.5,69.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN DILATION FEMALE URETHRA GEN/CONDUCTI,23553665,CDM,983,RC,53665,HCPCS,outpatient,,,127.75,63.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN PART EXC SUBURETHRAL CYST/CLOSURE FI,23553899,CDM,983,RC,53899,HCPCS,outpatient,,,1156,578,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN INCISION AND DRAIGE BARTHOLIN GLAN,23556420,CDM,983,RC,56420,HCPCS,outpatient,,,379,189.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN LYSIS OF LABIAL ADHESIONS,23556441,CDM,983,RC,56441,HCPCS,outpatient,,,400,200,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN DESTRUCTION OF LESION VULVA SIMPL,23556501,CDM,983,RC,56501,HCPCS,outpatient,,,396.5,198.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN DESTRUCTION LESION VULVA EXTENSIVE,23556515,CDM,983,RC,56515,HCPCS,outpatient,,,868.75,434.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN BIOPSY VULVA PERINEUM ONE,23556605,CDM,983,RC,56605,HCPCS,outpatient,,,261,130.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN VULVECTOMY SIMPLE PARTIAL,23556620,CDM,983,RC,56620,HCPCS,outpatient,,,1359.25,679.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN COLPO VULVA,23556820,CDM,983,RC,56820,HCPCS,outpatient,,,346,173,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN COLPO VULVA W BIOPSY,23556821,CDM,983,RC,56821,HCPCS,outpatient,,,463.5,231.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN DESTRUCITON VAGIL LESION SIMPLE LA,23557061,CDM,983,RC,57061,HCPCS,outpatient,,,343.75,171.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN DESTRUCITON VAGIL LESION EXTENSIVE,23557065,CDM,983,RC,57065,HCPCS,outpatient,,,520.25,260.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN BIOPSY VAGIL MUCOSA SIMPLE,23557100,CDM,983,RC,57100,HCPCS,outpatient,,,276.75,138.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN BIOPSY VAGIL MUCOSA EXT REQ SUTURE,23557105,CDM,983,RC,57105,HCPCS,outpatient,,,363.5,181.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN EXCISION OF VAGIL CYST OR TUMOR,23557135,CDM,983,RC,57135,HCPCS,outpatient,,,470.75,235.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN FITTING INSERT PESSARY INTRAVAG DE,23557160,CDM,983,RC,57160,HCPCS,outpatient,,,237.75,118.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN ANTERIOR COLPORRAPHY REPAIR CYSTOCEL,23557240,CDM,983,RC,57240,HCPCS,outpatient,,,1978,989,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN POSTERIOR COLPORRHAPHY RPR RECTOCELE,23557250,CDM,983,RC,57250,HCPCS,outpatient,,,2156.5,1078.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN COMBINED ANTEROPOSTERIOR COLPORRHAPH,23557260,CDM,983,RC,57260,HCPCS,outpatient,,,2437.75,1218.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN COMBINED ANTERIOPOSTERIOR COLP W/ENT,23557265,CDM,983,RC,57265,HCPCS,outpatient,,,2401.25,1200.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN INSERT MESH/PROSTHESIS RPR PELVIC FL,23557267,CDM,983,RC,57267,HCPCS,outpatient,,,830.5,415.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"GYN COLPOPEXY, VAGIL, EXTRAPERITONEAL",23557282,CDM,983,RC,57282,HCPCS,outpatient,,,1166.75,583.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"GYN COLPOPEXY, VAGIL, INTRA-PERITONEAL",23557283,CDM,983,RC,57283,HCPCS,outpatient,,,1934,967,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN REMOVAL/REVISION SLING STRESS INCONT,23557287,CDM,960,RC,57287,HCPCS,outpatient,,,2108.25,1054.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Replacement of sling to support the bladder,23557288,CDM,960,RC,57288,HCPCS,outpatient,,,2240.75,1120.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN REVISION OF PROSTHETIC VAGIL GRAFT,23557295,CDM,983,RC,57295,HCPCS,outpatient,,,1415.25,707.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN REVISION PROST VAG GRAFT OPEN ABDOMI,23557296,CDM,960,RC,57296,HCPCS,outpatient,,,2737,1368.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN CLOSURE RECTOVAGIL FISTULA,23557300,CDM,983,RC,57300,HCPCS,outpatient,,,2776,1388,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN COLPO W LEEP OF CX,23557400,CDM,983,RC,57400,HCPCS,outpatient,,,436,218,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN PELVIC EXAM UNDER ANES,23557410,CDM,983,RC,57410,HCPCS,outpatient,,,328.75,164.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN COLPO VAGIL W/CX,23557420,CDM,983,RC,57420,HCPCS,outpatient,,,364.5,182.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN COLPO VAGIL W/CX W BIOPSY,23557421,CDM,983,RC,57421,HCPCS,outpatient,,,491.75,245.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN COLPOSCOPY,23557452,CDM,983,RC,57452,HCPCS,outpatient,,,342.5,171.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Biopsy of cervix or uterus,23557454,CDM,983,RC,57454,HCPCS,outpatient,,,488.75,244.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN COLP W BIOP OF CERVIX,23557455,CDM,983,RC,57455,HCPCS,outpatient,,,449.5,224.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN COLP W BIOP OF ECC,23557456,CDM,983,RC,57456,HCPCS,outpatient,,,425.25,212.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN LEEP,23557460,CDM,983,RC,57460,HCPCS,outpatient,,,886.75,443.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN COLP W LEEP CONE OF CERVIX,23557461,CDM,983,RC,57461,HCPCS,outpatient,,,1001,500.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN BIOPSY OF CERVIX,23557500,CDM,983,RC,57500,HCPCS,outpatient,,,390.5,195.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN ENDOCERV CURTTAGE (NOT PART OF D&C),23557505,CDM,983,RC,57505,HCPCS,outpatient,,,309,154.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN CAUTERY CERVIX ELECTRO/THERMAL,23557510,CDM,983,RC,57510,HCPCS,outpatient,,,350.5,175.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN CERVICAL CRYOSURGERY,23557511,CDM,983,RC,57511,HCPCS,outpatient,,,449.5,224.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN CONIZATION CERVIX FULGURATION D&C LE,23557522,CDM,983,RC,57522,HCPCS,outpatient,,,784.5,392.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN EXCISION OF CERVICAL STUMP,23557550,CDM,983,RC,57550,HCPCS,outpatient,,,1828.5,914.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Biopsy of the lining of the uterus,23558100,CDM,983,RC,58100,HCPCS,outpatient,,,345,172.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN DILATION & CURETTAGE DX/THERAPEUTIC,23558120,CDM,983,RC,58120,HCPCS,outpatient,,,623,311.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN TOTAL ABDOMIL HYSTERECTOMY,23558150,CDM,960,RC,58150,HCPCS,outpatient,,,3036.75,1518.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN TAH W WO TUBES OVARIES W COLPOURETHR,23558152,CDM,983,RC,58152,HCPCS,outpatient,,,3415,1707.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN SUPRACERVICAL ABD HYSTERECTOMY W/W/O,23558180,CDM,983,RC,58180,HCPCS,outpatient,,,2732.75,1366.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN VAGIL HYSTERECTOMY <250G,23558260,CDM,983,RC,58260,HCPCS,outpatient,,,2533.5,1266.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN VAGIL HYSTERECTOMY <250G REM TUBE/,23558262,CDM,960,RC,58262,HCPCS,outpatient,,,2837.75,1418.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN VAGIL HYSTERECTOMY <250G REPAIR EN,23558270,CDM,983,RC,58270,HCPCS,outpatient,,,2382.75,1191.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN VAGIL HYSTERECTOMY >250G,23558290,CDM,983,RC,58290,HCPCS,outpatient,,,3566,1783,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN VAG HYSTERECTOMY UTERUS > 250G REMOV,23558291,CDM,960,RC,58291,HCPCS,outpatient,,,3878.75,1939.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN INSERTION OF IUD,23558300,CDM,983,RC,58300,HCPCS,outpatient,,,245,122.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN REMOVAL OF IUD,23558301,CDM,983,RC,58301,HCPCS,outpatient,,,300.25,150.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN CHROMOTUBATION OF OVIDUCT,23558350,CDM,983,RC,58350,HCPCS,outpatient,,,216.75,108.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN ENDOMETRIAL ABLATION THERMAL W/O HYS,23558353,CDM,983,RC,58353,HCPCS,outpatient,,,658.5,329.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN LAPAROSCOPY SURGICAL VAGIL HYSTERE,23558550,CDM,960,RC,58550,HCPCS,outpatient,,,2712.25,1356.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN LAP VAG HYSTERECTOMY UTERUS <250 G R,23558552,CDM,983,RC,58552,HCPCS,outpatient,,,2981.5,1490.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Surgical hysteroscopy with biopsy,23558558,CDM,983,RC,58558,HCPCS,outpatient,,,841.25,420.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN HYSTEROSCOPY SURG REMOVAL IMPACTED F,23558562,CDM,983,RC,58562,HCPCS,outpatient,,,891.5,445.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Surgical procedure used to treat premenopausal abnormal uterine bleeding,23558563,CDM,983,RC,58563,HCPCS,outpatient,,,1082.75,541.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN LAPAROSCOPIC PROCEDURE UTERUS,23558578,CDM,983,RC,58578,HCPCS,outpatient,,,891.5,445.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN LAPAROSCOPIC PROCEDURE UTERUS,23558579,CDM,983,RC,58579,HCPCS,outpatient,,,891.5,445.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN ESSURE PROCEDURE,23558615,CDM,983,RC,58615,HCPCS,outpatient,,,789.75,394.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN LAPROSCOPY SURG WITH LYSIS ADHESION,23558660,CDM,983,RC,58660,HCPCS,outpatient,,,3095,1547.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Removal of either benign or malignt tissue from the uterus, ovaries, fallopian tubes, or any of the surrounding tissues using a laparoscope",23558661,CDM,983,RC,58661,HCPCS,outpatient,,,1735.5,867.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Removal of lesions of the ovary, pelvic viscera, or peritoneal surface",23558662,CDM,983,RC,58662,HCPCS,outpatient,,,2023.5,1011.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Laparoscopic tubal sterilization is surgery to block the fallopian tubes to prevent pregncy,23558671,CDM,983,RC,58671,HCPCS,outpatient,,,1114.75,557.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN SALPINGO-OOPHORECTOMY,23558720,CDM,960,RC,58720,HCPCS,outpatient,,,2196.75,1098.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN OVARIAN CYSTECTOMY,23558925,CDM,983,RC,58925,HCPCS,outpatient,,,2240,1120,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN ADHESIONS VAGI,23558999,CDM,983,RC,58999,HCPCS,outpatient,,,513,256.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN TRT INCOMPLETE ABORTION SURGICALLY,23559812,CDM,983,RC,59812,HCPCS,outpatient,,,1313.75,656.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN INJECTION ANESTHETIC PUDENDAL NERVE,23564430,CDM,983,RC,64430,HCPCS,outpatient,,,232.75,116.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN PERCUT IMPLANT NEUROSTIMULATOR ELECT,23564561,CDM,960,RC,64561,HCPCS,outpatient,,,1284.5,642.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN INC IMPLANTATION NEUROSTIMULATOR ELE,23564581,CDM,960,RC,64581,HCPCS,outpatient,,,2503.5,1251.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN REVIS/REM PERIPHERAL NEUROSTIM ELECT,23564585,CDM,960,RC,64585,HCPCS,outpatient,,,437.75,218.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN INSERT/REPLACE PERIPHERAL/GASTRIC NE,23564590,CDM,960,RC,64590,HCPCS,outpatient,,,522.5,261.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN REVIS/REM PERIPH/GASTR NEUROST GEN/R,23564595,CDM,960,RC,64595,HCPCS,outpatient,,,387.25,193.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"GYN CHEMODENERVATION MUSC, FACIAL",23564612,CDM,983,RC,64612,HCPCS,outpatient,,,446.25,223.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Transvagil ultrasound of uterus,23576817,CDM,972,RC,76817,HCPCS,outpatient,,,145.5,72.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Complete ultrasound of the pelvis,23576856,CDM,983,RC,76856,HCPCS,outpatient,,,140,70,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Limited ultrasound of the pelvis,23576857,CDM,983,RC,76857,HCPCS,outpatient,,,81.75,40.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN US GUIDE FOR NEEDLE PLACEMENT,23576942,CDM,983,RC,76942,HCPCS,outpatient,,,138,69,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN COLECTOMY PARTIAL W ASTOMOSIS ASSI,23594140,CDM,983,RC,44140,HCPCS,outpatient,,,793.5,396.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN ELECTRONIC ALYSIS IMPLANTED NEUROS,23595972,CDM,960,RC,95972,HCPCS,outpatient,,,181.25,90.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN DRAIGE PERITONEAL ABSCESS ASSIST,23599020,CDM,983,RC,49020,HCPCS,outpatient,,,929.25,464.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN GLOBAL,23599024,CDM,969,RC,99024,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 10 minutes",23599202,CDM,983,RC,99202,HCPCS,outpatient,,,107,53.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 30 min",23599203,CDM,983,RC,99203,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 45 min",23599204,CDM,983,RC,99204,HCPCS,outpatient,,,265,132.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 60 min",23599205,CDM,983,RC,99205,HCPCS,outpatient,,,343.5,171.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient not requiring a physician,23599211,CDM,983,RC,99211,HCPCS,outpatient,,,24.5,12.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient requiring a physician,23599212,CDM,983,RC,99212,HCPCS,outpatient,,,56.5,28.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",23599213,CDM,983,RC,99213,HCPCS,outpatient,,,106.25,53.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 25 minutes",23599214,CDM,983,RC,99214,HCPCS,outpatient,,,162,81,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient, visit typically 40 minutes",23599215,CDM,983,RC,99215,HCPCS,outpatient,,,228.75,114.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN OBSERVATION DISCHARGE,23599217,CDM,983,RC,99217,HCPCS,outpatient,,,173.5,86.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN INITIAL OBSERVATION STRAIGHTFORWARD,23599218,CDM,987,RC,99218,HCPCS,outpatient,,,165.25,82.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN INITIAL OBSERVATION MODERATE COMP,23599219,CDM,983,RC,99219,HCPCS,outpatient,,,270.75,135.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN INITIAL OBSERVATION HIGH COMPLEXITY,23599220,CDM,987,RC,99220,HCPCS,outpatient,,,377.5,188.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN INITIAL HOSPITAL CARE LOW,23599221,CDM,987,RC,99221,HCPCS,outpatient,,,234.25,117.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN INITIAL HOSPITAL CARE MODERATE,23599222,CDM,987,RC,99222,HCPCS,outpatient,,,318.5,159.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN INITIAL HOSPITAL CARE HIGH COMPLEX,23599223,CDM,987,RC,99223,HCPCS,outpatient,,,465.25,232.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN SUBSEQ OBS LOW COMPLEXITY,23599224,CDM,987,RC,99224,HCPCS,outpatient,,,79.75,39.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN SUBSEQ OBS MOD COMPLEXITY,23599225,CDM,987,RC,99225,HCPCS,outpatient,,,137,68.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN SUBSEQ OBS HIGH COMPLEXITY,23599226,CDM,987,RC,99226,HCPCS,outpatient,,,203,101.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN SUBSEQUENT HOSPITAL CARE LOW,23599231,CDM,987,RC,99231,HCPCS,outpatient,,,99,49.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN SUBSEQUENT HOSPITAL CARE MODERATE,23599232,CDM,987,RC,99232,HCPCS,outpatient,,,174.75,87.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN SUBSEQUENT HOSPITAL CARE HIGH,23599233,CDM,987,RC,99233,HCPCS,outpatient,,,248.25,124.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN OBS OR INP ADM SAME DAY LOW COMP,23599234,CDM,987,RC,99234,HCPCS,outpatient,,,329.75,164.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN OBS OR INP ADM SAME DAY MOD COMP,23599235,CDM,987,RC,99235,HCPCS,outpatient,,,432,216,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN OBS OR INP ADM SAME DAY HIGH COMP,23599236,CDM,987,RC,99236,HCPCS,outpatient,,,535.5,267.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN HOSPITAL DISCHARE DAY 30 MIN OR LESS,23599238,CDM,987,RC,99238,HCPCS,outpatient,,,172.25,86.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN HOSPITAL DISCHARE DAY >30 MIN,23599239,CDM,987,RC,99239,HCPCS,outpatient,,,248.75,124.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN EMERGENCY DEPT VISIT LOW,23599282,CDM,981,RC,99282,HCPCS,outpatient,,,106.75,53.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, moderately severe problem",23599283,CDM,981,RC,99283,HCPCS,outpatient,,,164.75,82.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN CRITICAL CARE 1ST HOUR,23599291,CDM,987,RC,99291,HCPCS,outpatient,,,641.75,320.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN CRITICAL CARE EA ADD 30 MIN,23599292,CDM,987,RC,99292,HCPCS,outpatient,,,277.5,138.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
New preventative visit in new patients 12-17 years old,23599384,CDM,983,RC,99384,HCPCS,outpatient,,,178,89,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial new patient preventive medicine evaluation (18?9 years),23599385,CDM,983,RC,99385,HCPCS,outpatient,,,178,89,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial new patient preventive medicine evaluation (40?4 years),23599386,CDM,983,RC,99386,HCPCS,outpatient,,,217.5,108.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial visit for new patients 65 and older years old,23599387,CDM,983,RC,99387,HCPCS,outpatient,,,237.75,118.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
New preventative visit in new patients 12-17 years old,23599394,CDM,983,RC,99394,HCPCS,outpatient,,,158.25,79.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Established patient periodic preventive medicine examition age 18-39 years,23599395,CDM,983,RC,99395,HCPCS,outpatient,,,158.25,79.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Established patient periodic preventive medicine examition age 40-64 years,23599396,CDM,983,RC,99396,HCPCS,outpatient,,,178,89,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Periodic primary re-evaluation for an established patient 65 and older,23599397,CDM,983,RC,99397,HCPCS,outpatient,,,198.5,99.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN SMOKING CESSATION COUNSELING >10 MIN,23599407,CDM,983,RC,99407,HCPCS,outpatient,,,54.5,27.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
GYN PAP EXAM (MEDICARE INCLUDING BREAST),23599999,CDM,983,RC,G0101,HCPCS,outpatient,,,84,42,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK WELLNESS INITIAL ANNUAL VISIT W PPS,25000100,CDM,982,RC,G0438,HCPCS,outpatient,,,329,164.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK WELLNESS SUBSEQ  ANNUAL VISIT W PPS,25000101,CDM,982,RC,G0439,HCPCS,outpatient,,,273.25,136.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK FALL RISK SCREENING 1100F,25000102,CDM,969,RC,1100F,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK DEPRESSION SCREENING 3725F,25000103,CDM,969,RC,3725F,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK SCREENING DEPRESSION IN ADULTS 15 MIN,25000104,CDM,983,RC,G0444,HCPCS,outpatient,,,22,11,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK INFLUENZA ORDERED OR ADMIN 4037F,25000105,CDM,969,RC,4037F,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK PNEUMOCOCCAL ORDERED OR ADMIN 4040F,25000106,CDM,969,RC,4040F,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK HYPERTENSION PLAN OF CARE 4050F,25000107,CDM,969,RC,4050F,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK TOBACCO SCREEN CESS INTER 4004F,25000108,CDM,969,RC,4004F,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK COGNI IMPAIR DISFUNC ASSESSMENT 3720F,25000109,CDM,969,RC,3720F,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK BMI ABOVE NORMAL W FU PLAN G8417,25000110,CDM,969,RC,G8417,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK OBESITY BEHAVIORAL THERAPY 15MIN,25000111,CDM,983,RC,G0447,HCPCS,outpatient,,,54.5,27.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK ALCOHOL MISUSE SCREEN 15 MIN ANNUAL,25000113,CDM,983,RC,G0442,HCPCS,outpatient,,,22,11,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK BEHAVIORAL COUNS ALCOHOL 15 MIN,25000114,CDM,983,RC,G0443,HCPCS,outpatient,,,54.5,27.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK IPPE WELCOME TO MEDICARE,25000115,CDM,983,RC,G0402,HCPCS,outpatient,,,231.75,115.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK CVD INTENSIVE BEHAVIORA 15 MIN F TO F,25000116,CDM,983,RC,G0446,HCPCS,outpatient,,,54.5,27.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK COUNSELING LUNG CANCER SCREEN LDCT,25000296,CDM,983,RC,G0296,HCPCS,outpatient,,,49.75,24.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK REMOVAL OF SUTURES PHYSICIAN OTHER TH,25000630,CDM,983,RC,S0630,HCPCS,outpatient,,,43.5,21.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK TH MEDICAL DISCUSSION 5-10 MIN,25002012,CDM,982,RC,G2012,HCPCS,outpatient,,,33.5,16.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK CHRONIC CARE MGMT EACH ADDTL 20 MIN,25002058,CDM,983,RC,G2058,HCPCS,outpatient,,,50,25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 5-10 minutes of medical discussion",25008441,CDM,983,RC,99441,HCPCS,outpatient,,,58.75,29.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 11-20 minutes of medical discussion",25008442,CDM,983,RC,99442,HCPCS,outpatient,,,106.75,53.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 21-30 minutes of medical discussion",25008443,CDM,983,RC,99443,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK TH TRANSITIOL CARE MGMT MOD COMPLEX,25008495,CDM,983,RC,99495,HCPCS,outpatient,,,341.5,170.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK TH TRANSITION CARE MGMT HIGH COMPLEX,25008496,CDM,983,RC,99496,HCPCS,outpatient,,,485,242.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 10 minutes",25008902,CDM,983,RC,99202,HCPCS,outpatient,,,107,53.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 30 min",25008903,CDM,983,RC,99203,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 45 min",25008904,CDM,983,RC,99204,HCPCS,outpatient,,,265,132.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 60 min",25008905,CDM,983,RC,99205,HCPCS,outpatient,,,343.5,171.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient not requiring a physician,25008911,CDM,983,RC,99211,HCPCS,outpatient,,,24.5,12.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient requiring a physician,25008912,CDM,983,RC,99212,HCPCS,outpatient,,,56.5,28.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",25008913,CDM,983,RC,99213,HCPCS,outpatient,,,106.25,53.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 25 minutes",25008914,CDM,983,RC,99214,HCPCS,outpatient,,,162,81,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient, visit typically 40 minutes",25008915,CDM,983,RC,99215,HCPCS,outpatient,,,228.75,114.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK CHRONIC CARE MGMT 30 MIN OR >/MTH,25009491,CDM,983,RC,99491,HCPCS,outpatient,,,138.25,69.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Fine Needle Aspiration Biopsy without imaging,25010021,CDM,983,RC,10021,HCPCS,outpatient,,,375.75,187.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Incision and draige of abscess; simple or single and complex or multiple,25010060,CDM,983,RC,10060,HCPCS,outpatient,,,242.75,121.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK ABCESS I&D (MULTIPLE OR COMPLEX),25010061,CDM,983,RC,10061,HCPCS,outpatient,,,430,215,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK FOREIGN BODY REMOVAL(SQ SIMPLE),25010120,CDM,983,RC,10120,HCPCS,outpatient,,,236.25,118.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK VFC HEP B (RECOMBIVAX),25010744,CDM,983,RC,90744,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of infected skin,25011000,CDM,983,RC,11000,HCPCS,outpatient,,,149.75,74.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK DEBRIDEMENT SKIN SUBCUT TISSUE,25011042,CDM,983,RC,11042,HCPCS,outpatient,,,135.25,67.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK PARING CUTTING BEN HYPERKERATOTIC LES,25011055,CDM,983,RC,11055,HCPCS,outpatient,,,69.5,34.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Paring or cutting of benign hyperkeratotic lesion,25011056,CDM,983,RC,11056,HCPCS,outpatient,,,94.75,47.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK PARING CUT BEN HYPERKER LES > 4,25011057,CDM,983,RC,11057,HCPCS,outpatient,,,123.75,61.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Tangential biopsy of skin (e.g., for example, shave, scoop, saucerize, curette); single lesion",25011102,CDM,983,RC,11102,HCPCS,outpatient,,,94.25,47.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK PUNCH BX SKIN SINGLE LESION,25011104,CDM,983,RC,11104,HCPCS,outpatient,,,118.25,59.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Removal of skin tags, multiple fibrocutaneous tags, any area",25011200,CDM,983,RC,11200,HCPCS,outpatient,,,169.75,84.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK REMOVAL SKIN TAGS EA ADDTL 10 OR PART,25011201,CDM,983,RC,11201,HCPCS,outpatient,,,48.75,24.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK SHAVE EPID DERMAL LES SINGLE <.5 CM,25011300,CDM,983,RC,11300,HCPCS,outpatient,,,82.25,41.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK SHAVE EPID DERMAL LES SINGLE .6-1.0,25011301,CDM,983,RC,11301,HCPCS,outpatient,,,135.25,67.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK SHAVE EPID DERMAL LES SINGLE 1.1-2.0,25011302,CDM,983,RC,11302,HCPCS,outpatient,,,167,83.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK SHAVE EPID DERMAL LES SINGLE >2.0,25011303,CDM,983,RC,11303,HCPCS,outpatient,,,195.25,97.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK SHAVE EPID DERMAL LES SINGLE <.5 C,25011305,CDM,983,RC,11305,HCPCS,outpatient,,,105.25,52.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK SHAVING EPIDERMAL OR DERMAL LESION .6,25011306,CDM,983,RC,11306,HCPCS,outpatient,,,154.25,77.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK SHAVING EPIDERMAL/DERM LES 1.1-2.0CM,25011307,CDM,983,RC,11307,HCPCS,outpatient,,,179.75,89.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK SHAVING EPIDER DERMAL LESION SCALP NE,25011308,CDM,983,RC,11308,HCPCS,outpatient,,,222.5,111.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK EXCISION BEN .5 CM OR LESS,25011400,CDM,983,RC,11400,HCPCS,outpatient,,,187,93.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Under Excision-Benign Lesions Procedures on the Skin 0.6-1 CM,25011401,CDM,983,RC,11401,HCPCS,outpatient,,,250.5,125.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK EXCISION BEN 1.1 TO 2.0 CM,25011402,CDM,983,RC,11402,HCPCS,outpatient,,,278.75,139.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK EXCISION BEN 2.1 TO 3.0 CM,25011403,CDM,983,RC,11403,HCPCS,outpatient,,,354.75,177.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK EXCISION BEN 3.1 TO 4.0 CM,25011404,CDM,983,RC,11404,HCPCS,outpatient,,,395.75,197.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK EXCISION BEN > 4.0 CM,25011406,CDM,983,RC,11406,HCPCS,outpatient,,,596.75,298.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK EXCISION BEN LESION <.5 CM,25011440,CDM,983,RC,11440,HCPCS,outpatient,,,240,120,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK EXCISE MALIG LESION <.5CM,25011600,CDM,983,RC,11600,HCPCS,outpatient,,,596.75,298.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK DEBRIDEMENT IL 1-5,25011720,CDM,983,RC,11720,HCPCS,outpatient,,,51.5,25.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of 6 or more ils,25011721,CDM,983,RC,11721,HCPCS,outpatient,,,85,42.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Separation and removal of the entire il plate or a portion of il plate,25011730,CDM,983,RC,11730,HCPCS,outpatient,,,168.5,84.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK SUBUNGUAL HEMATOMA EVAC,25011740,CDM,983,RC,11740,HCPCS,outpatient,,,84,42,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK IL REMOVAL PART OR COMP,25011750,CDM,983,RC,11750,HCPCS,outpatient,,,451.5,225.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK INSERTION NONBIODEGRADABLE DRUG IMPLA,25011981,CDM,983,RC,11981,HCPCS,outpatient,,,261.25,130.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK REMOVAL NONBIODEGRADABLE DRUG DELIVE,25011982,CDM,983,RC,11982,HCPCS,outpatient,,,275.5,137.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK REMOVAL/INSERT NONBIODEGR DRUG IMPLA,25011983,CDM,983,RC,11983,HCPCS,outpatient,,,538.5,269.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Simple repair of superficial wounds of scalp, neck, axillae, exterl genitalia, trunk and/or extremities",25012001,CDM,983,RC,12001,HCPCS,outpatient,,,196.5,98.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK SIMP RPR SUPERFICIAL WD 2.6 TO 7.5 CM,25012002,CDM,983,RC,12002,HCPCS,outpatient,,,218.25,109.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK SIMP RPR SUPERFICIAL WD 7.5 TO 12.5 C,25012004,CDM,983,RC,12004,HCPCS,outpatient,,,256.25,128.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK SIMP RPR SUPERFICIAL WD 12.6 TO 20.0M,25012005,CDM,983,RC,12005,HCPCS,outpatient,,,319.75,159.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK SIMP RPR SUPERFICIAL WD 20.1 TO 30.0,25012006,CDM,983,RC,12006,HCPCS,outpatient,,,403.5,201.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK LAC REPAIR >30 CM,25012007,CDM,983,RC,12007,HCPCS,outpatient,,,646.5,323.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes",25012011,CDM,983,RC,12011,HCPCS,outpatient,,,203.75,101.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK SIMP RPR FACE 2.6-5 CM,25012013,CDM,983,RC,12013,HCPCS,outpatient,,,231.25,115.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK SIMP RPR SUPERFICIAL WD 5.1 TO 7.5 CM,25012014,CDM,983,RC,12014,HCPCS,outpatient,,,278.75,139.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK SIMP RPR SUPERFICIAL WD 7.6 TO12.5 CM,25012015,CDM,983,RC,12015,HCPCS,outpatient,,,349.5,174.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK SIMP RPR SUPERFICIAL WD 12.6 -20CM,25012016,CDM,983,RC,12016,HCPCS,outpatient,,,427,213.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"FK DEBRIDEMENT, SKIN",25016020,CDM,983,RC,16020,HCPCS,outpatient,,,108.25,54.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of pre-cancerous lesion,25017000,CDM,983,RC,17000,HCPCS,outpatient,,,136,68,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of 2-14 pre-cancerous lesions,25017003,CDM,983,RC,17003,HCPCS,outpatient,,,16.25,8.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK CRYO LESIONS >15,25017004,CDM,983,RC,17004,HCPCS,outpatient,,,343.5,171.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of 1-14 common or plantar warts,25017110,CDM,983,RC,17110,HCPCS,outpatient,,,167.75,83.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of >15 common or plantar warts,25017111,CDM,983,RC,17111,HCPCS,outpatient,,,209.5,104.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK INJECTION CARPAL TUNNEL,25020526,CDM,983,RC,20526,HCPCS,outpatient,,,162.25,81.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Injection of medication into a tendon or ligament,25020550,CDM,983,RC,20550,HCPCS,outpatient,,,86.75,43.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK TRIGGER PT INJ MUS,25020552,CDM,983,RC,20552,HCPCS,outpatient,,,102.75,51.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Injection of medication into an area that triggers pain,25020553,CDM,983,RC,20553,HCPCS,outpatient,,,112.75,56.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a small joint/bursa without ultrasound,25020600,CDM,983,RC,20600,HCPCS,outpatient,,,114,57,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a large joint/bursa without ultrasound,25020605,CDM,983,RC,20605,HCPCS,outpatient,,,92.75,46.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a major joint/bursa without ultrasound,25020610,CDM,983,RC,20610,HCPCS,outpatient,,,112.75,56.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of fluid or injection of medication into a ganglion cyst,25020612,CDM,983,RC,20612,HCPCS,outpatient,,,123.75,61.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK APP LONG ARM CAST,25029105,CDM,983,RC,29105,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK APPLICATION SHORT ARM SPLINT STATIC,25029125,CDM,983,RC,29125,HCPCS,outpatient,,,109,54.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK STRAPPING UN BOOT,25029580,CDM,983,RC,29580,HCPCS,outpatient,,,102,51,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK REMOVAL/BIVALVING GAUNT BOOT,25029700,CDM,983,RC,29700,HCPCS,outpatient,,,100,50,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK REMOVE FOR BODY INTRASAL,25030300,CDM,983,RC,30300,HCPCS,outpatient,,,293.5,146.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK ABLATIN SOFT TISSUE INFERIOR TURBIT,25030801,CDM,983,RC,30801,HCPCS,outpatient,,,317.25,158.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK CONTROL SAL HEMORR ANTERIOR SIMPL,25030901,CDM,983,RC,30901,HCPCS,outpatient,,,238.5,119.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK VENIPUNCTURE <AGE 3 SCALP VEIN,25036405,CDM,983,RC,36405,HCPCS,outpatient,,,128.5,64.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK CAPILLARY BLOOD,25036416,CDM,983,RC,36416,HCPCS,outpatient,,,16.5,8.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK REMOVAL FOREIGN BODY PHARYNX,25042809,CDM,983,RC,42809,HCPCS,outpatient,,,338.25,169.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK EXTERL INCISION HEMORRHOIDS,25046083,CDM,983,RC,46083,HCPCS,outpatient,,,194,97,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK ANOSCOPY DIAG COLLECTION OF SPECIMEN,25046600,CDM,983,RC,46600,HCPCS,outpatient,,,74.75,37.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a small joint/bursa without ultrasound,25050600,CDM,983,RC,20600,HCPCS,outpatient,,,227.75,113.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK BLADDER CATHETER NON DWELL,25051701,CDM,983,RC,51701,HCPCS,outpatient,,,84,42,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK BLADDER CATH SMPLE INDWELLING,25051702,CDM,983,RC,51702,HCPCS,outpatient,,,90.5,45.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK DESTRUCTION LESION PENIS SIMP CRYO,25054056,CDM,983,RC,54056,HCPCS,outpatient,,,266.75,133.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK CIRCUMCISION SURG EXCISION,25054160,CDM,983,RC,54160,HCPCS,outpatient,,,426.75,213.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK CIRCUMCISION SURG EXCISION > 28 DAYS,25054161,CDM,983,RC,54161,HCPCS,outpatient,,,640,320,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK ADHESIONS OF PENIS POST CIRCUMCISION,25054162,CDM,983,RC,54162,HCPCS,outpatient,,,567.25,283.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK INCISION AND DRAIGE VULVA PERINEAL,25056405,CDM,983,RC,56405,HCPCS,outpatient,,,285.5,142.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK FITTING INSERT PESSARY INTRAVAG DEVIC,25057160,CDM,983,RC,57160,HCPCS,outpatient,,,237.75,118.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Biopsy of the lining of the uterus,25058100,CDM,983,RC,58100,HCPCS,outpatient,,,247.5,123.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK IUD INSERTION,25058300,CDM,983,RC,58300,HCPCS,outpatient,,,159,79.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK IUD REMOVAL,25058301,CDM,983,RC,58301,HCPCS,outpatient,,,195.75,97.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Vagil delivery,25059409,CDM,983,RC,59409,HCPCS,outpatient,,,2963.5,1481.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK INJ ANESTHETIC AGT OTH PERIPHERAL NE,25064450,CDM,983,RC,64450,HCPCS,outpatient,,,204,102,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK REMOVAL FOR BODY EXT EYE CONJ SUPER,25065205,CDM,983,RC,65205,HCPCS,outpatient,,,111.75,55.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK REMOVAL FOR BODY CORNEAL WO SLIT,25065220,CDM,983,RC,65220,HCPCS,outpatient,,,82.25,41.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK DRAIN EXT EAR ABSCESS HEMATOMA SIMP,25069000,CDM,983,RC,69000,HCPCS,outpatient,,,296.25,148.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK FOREIGN BDY REMOVAL AUDITORY CAL,25069200,CDM,983,RC,69200,HCPCS,outpatient,,,110.25,55.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK REMOVAL IMPACTED CERUMEN IRRIG/LAVAGE,25069209,CDM,983,RC,69209,HCPCS,outpatient,,,22.75,11.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of ear wax from one or both ears,25069210,CDM,983,RC,69210,HCPCS,outpatient,,,68.25,34.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Hepatitis A vaccition for adolescents and children,25090633,CDM,983,RC,90633,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK VFC HIB PRPT(ACTHIB):0.5 ML,25090648,CDM,983,RC,90648,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
3-dose HPV vaccition,25090649,CDM,983,RC,90649,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK VFC HPV-9 (GARDASIL 9),25090651,CDM,983,RC,90651,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK VFC PCV13 PNEUMOCOCCAL (PREVR),25090670,CDM,983,RC,90670,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK VFC ROTAVIRUS (ROTATEQ),25090680,CDM,983,RC,90680,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK VFC DTaP/IPV (QUADRACEL) (KINRIX),25090696,CDM,983,RC,90696,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK VFC DTAP/IPV/HIB (PENTACEL),25090698,CDM,983,RC,90698,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK VFC DTaP (DAPTACEL) (INFANRIX),25090700,CDM,983,RC,90700,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Measles, mumps and rubella vaccine",25090707,CDM,983,RC,90707,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"measlesMeasles, mumps, rubella and varicella vaccine",25090710,CDM,983,RC,90710,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Diphtheria, tetanus acellular, and pertussis vaccine for adults",25090715,CDM,983,RC,90715,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Varicella vaccine,25090716,CDM,983,RC,90716,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK VFC DTAP/HEPB/IPV (PEDIARIX),25090723,CDM,983,RC,90723,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
meningococcal Meningococcal conjugate vaccine,25090734,CDM,983,RC,90734,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK VFC ENERGIX B,25090744,CDM,983,RC,90744,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK EKG INTERP,25093010,CDM,983,RC,93010,HCPCS,outpatient,,,25.5,12.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK ECG 1-3 INT AND REPORT,25093042,CDM,983,RC,93042,HCPCS,outpatient,,,32,16,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK CALITH REPOSITIONING MANEUVER,25095992,CDM,983,RC,95992,HCPCS,outpatient,,,137.5,68.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Debridement (for example, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps)",25097597,CDM,983,RC,97597,HCPCS,outpatient,,,70.5,35.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK GLOBAL,25099024,CDM,969,RC,99024,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK EMERGENCY AFTER HOURS SERVICE,25099050,CDM,983,RC,99050,HCPCS,outpatient,,,47.25,23.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK EMERGENCY SERVICE IN OFFICE,25099058,CDM,983,RC,99058,HCPCS,outpatient,,,55.5,27.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK EMERGENCY SERVICE OUT OFFICE,25099060,CDM,983,RC,99060,HCPCS,outpatient,,,63.25,31.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 10 minutes",25099202,CDM,983,RC,99202,HCPCS,outpatient,,,107,53.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 30 min",25099203,CDM,983,RC,99203,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 45 min",25099204,CDM,983,RC,99204,HCPCS,outpatient,,,265,132.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 60 min",25099205,CDM,983,RC,99205,HCPCS,outpatient,,,343.5,171.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient not requiring a physician,25099211,CDM,983,RC,99211,HCPCS,outpatient,,,24.5,12.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient requiring a physician,25099212,CDM,983,RC,99212,HCPCS,outpatient,,,56.5,28.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",25099213,CDM,983,RC,99213,HCPCS,outpatient,,,106.25,53.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 25 minutes",25099214,CDM,983,RC,99214,HCPCS,outpatient,,,162,81,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient, visit typically 40 minutes",25099215,CDM,983,RC,99215,HCPCS,outpatient,,,228.75,114.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK OBSERV DISCHARGE DAY MGMT,25099217,CDM,983,RC,99217,HCPCS,outpatient,,,173.5,86.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK INIT OBS PER DAY LOW COMPLEX,25099218,CDM,983,RC,99218,HCPCS,outpatient,,,165.25,82.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK INIT OBS PER DAY MOD COMPLEX,25099219,CDM,983,RC,99219,HCPCS,outpatient,,,270.75,135.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK INIT OBS PER DAY HIGH COMPLEX,25099220,CDM,983,RC,99220,HCPCS,outpatient,,,377.5,188.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK INIT IP HOSP LOW COMPLEX,25099221,CDM,983,RC,99221,HCPCS,outpatient,,,234.25,117.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK INIT IP HOSP MOD COMPLEXITY,25099222,CDM,983,RC,99222,HCPCS,outpatient,,,318.5,159.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK INIT IP HOSP HIGH COMPLEXITY,25099223,CDM,983,RC,99223,HCPCS,outpatient,,,465.25,232.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK OBS SUB FOCUSED COMPLEXITY,25099224,CDM,983,RC,99224,HCPCS,outpatient,,,79.75,39.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK OBS SUB EXPANDED COMPLEXITY,25099225,CDM,983,RC,99225,HCPCS,outpatient,,,137,68.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK OBS SUB HIGH COMPLEXITY,25099226,CDM,983,RC,99226,HCPCS,outpatient,,,203,101.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK SUBQ HOSPITAL CARE LOW COMPLEXITY,25099231,CDM,983,RC,99231,HCPCS,outpatient,,,99,49.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK SUBQ HOSPITAL CARE MOD COMPLEXITY,25099232,CDM,983,RC,99232,HCPCS,outpatient,,,174.75,87.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK SUBQ HOSPITAL CARE HIGH COMPLEXITY,25099233,CDM,983,RC,99233,HCPCS,outpatient,,,248.25,124.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK OBS IP ADMIT DISC SAME DAY LOW,25099234,CDM,983,RC,99234,HCPCS,outpatient,,,329.75,164.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK OBS IP ADMIT DISC SAME DAY MODERATE,25099235,CDM,983,RC,99235,HCPCS,outpatient,,,432,216,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK OBS IP ADMIT DISC SAME DAY HIGH,25099236,CDM,983,RC,99236,HCPCS,outpatient,,,535.5,267.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK HOSPITAL DISCHARGE DAY MGMT < 30 MIN,25099238,CDM,983,RC,99238,HCPCS,outpatient,,,172.25,86.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK HOSPITAL DISCHARGE DAY MGMT > 30 MIN,25099239,CDM,983,RC,99239,HCPCS,outpatient,,,248.75,124.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, moderately severe problem",25099283,CDM,983,RC,99283,HCPCS,outpatient,,,164.75,82.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem of high severity",25099284,CDM,983,RC,99284,HCPCS,outpatient,,,307.75,153.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Emergency department visit, problem with significant threat to life or function",25099285,CDM,983,RC,99285,HCPCS,outpatient,,,458.25,229.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK CRITICAL CARE 1ST 30 TO 74 MIN,25099291,CDM,983,RC,99291,HCPCS,outpatient,,,502.75,251.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK CRITICAL CARE ADDL 1/2 HR,25099292,CDM,983,RC,99292,HCPCS,outpatient,,,252,126,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK NURS FAC INIT/ANNUAL LOW COMPLEX,25099304,CDM,983,RC,99304,HCPCS,outpatient,,,210.25,105.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK NURS FAC INIT/ANNUAL MOD COMPLEX,25099305,CDM,983,RC,99305,HCPCS,outpatient,,,294.25,147.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK NURS FAC INIT/ANNUAL HIGH COMPLEX,25099306,CDM,983,RC,99306,HCPCS,outpatient,,,378.25,189.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK NURS FAC SUB CARE STRAIGHT FORWARD,25099307,CDM,983,RC,99307,HCPCS,outpatient,,,104.5,52.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK NURS FAC SUB CARE LOW COMPLEX,25099308,CDM,983,RC,99308,HCPCS,outpatient,,,158.25,79.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK NURS FAC SUB CARE MOD COMPLEX,25099309,CDM,983,RC,99309,HCPCS,outpatient,,,210.5,105.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK NURS FAC SUB CARE HIGH COMPLEX,25099310,CDM,983,RC,99310,HCPCS,outpatient,,,310.5,155.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK NURS FAC DISCHARGE > 30 MIN,25099315,CDM,983,RC,99315,HCPCS,outpatient,,,152.75,76.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK NURS FAC DISCHARGE < 30 MIN,25099316,CDM,983,RC,99316,HCPCS,outpatient,,,199,99.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK NURS FAC ANNUAL EXAM LOW TO MOD,25099318,CDM,983,RC,99318,HCPCS,outpatient,,,220,110,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK HOME VISIT NEW MOD COMPLEX,25099344,CDM,983,RC,99344,HCPCS,outpatient,,,389.5,194.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK HOME VISIT PROBLEM FOCUSED,25099347,CDM,983,RC,99347,HCPCS,outpatient,,,123.75,61.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK HOME VISIT EXPANDED LOW COMPLEX,25099348,CDM,983,RC,99348,HCPCS,outpatient,,,185.75,92.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK HOME VISIT DETAILED MOD COMPLEXITY,25099349,CDM,983,RC,99349,HCPCS,outpatient,,,271.25,135.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK HOME VISIT COMPREH MOD HIGH COMPLEX,25099350,CDM,983,RC,99350,HCPCS,outpatient,,,378.5,189.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK PROLONGED SERVICES 30-74 MIN,25099354,CDM,983,RC,99354,HCPCS,outpatient,,,205,102.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK PROLONGED SERVICES EA ADDL 30 MIN,25099355,CDM,983,RC,99355,HCPCS,outpatient,,,202.75,101.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial visit for an infant,25099381,CDM,983,RC,99381,HCPCS,outpatient,,,140,70,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial visit for new patients 1-4 years old,25099382,CDM,983,RC,99382,HCPCS,outpatient,,,159,79.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
New preventative visit in new patients 5-11 years old,25099383,CDM,983,RC,99383,HCPCS,outpatient,,,159,79.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
New preventative visit in new patients 12-17 years old,25099384,CDM,983,RC,99384,HCPCS,outpatient,,,179.75,89.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial new patient preventive medicine evaluation (18?9 years),25099385,CDM,983,RC,99385,HCPCS,outpatient,,,179.75,89.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial new patient preventive medicine evaluation (40?4 years),25099386,CDM,983,RC,99386,HCPCS,outpatient,,,220,110,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial visit for new patients 65 and older years old,25099387,CDM,983,RC,99387,HCPCS,outpatient,,,240.75,120.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Periodic primary re-evaluation for an established infant patient,25099391,CDM,983,RC,99391,HCPCS,outpatient,,,119.75,59.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial visit for new patients 1-4 years old,25099392,CDM,983,RC,99392,HCPCS,outpatient,,,140,70,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
New preventative visit in new patients 5-11 years old,25099393,CDM,983,RC,99393,HCPCS,outpatient,,,140,70,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
New preventative visit in new patients 12-17 years old,25099394,CDM,983,RC,99394,HCPCS,outpatient,,,159,79.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Established patient periodic preventive medicine examition age 18-39 years,25099395,CDM,983,RC,99395,HCPCS,outpatient,,,159,79.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Established patient periodic preventive medicine examition age 40-64 years,25099396,CDM,983,RC,99396,HCPCS,outpatient,,,179.75,89.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Periodic primary re-evaluation for an established patient 65 and older,25099397,CDM,983,RC,99397,HCPCS,outpatient,,,200.75,100.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK ESTAB PT PREV COUNSEL 15 MIN,25099401,CDM,983,RC,99401,HCPCS,outpatient,,,54.5,27.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK NEW/ESTAB PT PREV COUNSEL 30 MIN,25099402,CDM,983,RC,99402,HCPCS,outpatient,,,111.5,55.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK NEW/ESTAB PT PREV COUNSEL 45 MIN,25099403,CDM,983,RC,99403,HCPCS,outpatient,,,166.25,83.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK NEW/ESTAB PT PREV COUNSEL 60 MIN,25099404,CDM,983,RC,99404,HCPCS,outpatient,,,221.5,110.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK TOBACCO COUNSELING  3-10 MIN,25099406,CDM,983,RC,99406,HCPCS,outpatient,,,27.25,13.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK SMOKING COUNSEL>10 MIN,25099407,CDM,983,RC,99407,HCPCS,outpatient,,,54.5,27.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK ALCOHOL/SUB ABUSE SCREEN 15-30 MIN,25099408,CDM,983,RC,99408,HCPCS,outpatient,,,72.75,36.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK ALCOHOL/SUB ABUSE SCREEN >30 MIN,25099409,CDM,983,RC,99409,HCPCS,outpatient,,,146.25,73.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK UNLISTED PREVENTATIVE SCHOOL PHYSICAL,25099429,CDM,983,RC,99429,HCPCS,outpatient,,,25,12.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 5-10 minutes of medical discussion",25099441,CDM,983,RC,99441,HCPCS,outpatient,,,31,15.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 11-20 minutes of medical discussion",25099442,CDM,983,RC,99442,HCPCS,outpatient,,,59.25,29.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 21-30 minutes of medical discussion",25099443,CDM,983,RC,99443,HCPCS,outpatient,,,86.25,43.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK DHHR PHYSICAL,25099450,CDM,983,RC,99450,HCPCS,outpatient,,,263,131.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK DISABILITY EXAMITION,25099455,CDM,983,RC,99455,HCPCS,outpatient,,,263,131.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK DISABILITY EXAM-NOT TREATING MD,25099456,CDM,983,RC,99456,HCPCS,outpatient,,,263,131.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK TRANSITIOL CARE MGMT MOD COMPLEX,25099495,CDM,983,RC,99495,HCPCS,outpatient,,,341.5,170.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK TRANSITIOL CARE MGMT HIGH COMPLEX,25099496,CDM,983,RC,99496,HCPCS,outpatient,,,485,242.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK CHRONIC CARE MGMT EACH ADDTL 20 MIN,25099939,CDM,983,RC,99439,HCPCS,outpatient,,,42.75,21.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK CHRONIC CARE MGMT 20 MIN,25099990,CDM,983,RC,99490,HCPCS,outpatient,,,51.75,25.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK CHRONIC CARE MGMT PRO 60 MIN,25099991,CDM,983,RC,99487,HCPCS,outpatient,,,83.75,41.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK CHRONIC CARE MGMT PRO EA ADD 30,25099992,CDM,983,RC,99489,HCPCS,outpatient,,,42.5,21.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK CHRONIC CARE MGMT CMP ASSESSMENT,25099995,CDM,983,RC,G0506,HCPCS,outpatient,,,105.25,52.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient not requiring a physician,25099996,CDM,983,RC,99211,HCPCS,outpatient,,,100,50,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient not requiring a physician,25099997,CDM,983,RC,99211,HCPCS,outpatient,,,100,50,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient not requiring a physician,25500011,CDM,969,RC,99211,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient requiring a physician,25500012,CDM,969,RC,99212,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",25500013,CDM,969,RC,99213,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 25 minutes",25500014,CDM,969,RC,99214,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient, visit typically 40 minutes",25500015,CDM,969,RC,99215,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF WELLNESS INITIAL ANNUAL VISIT W PPS,25500100,CDM,982,RC,G0438,HCPCS,outpatient,,,329,164.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF WELLNESS SUBSEQ  ANNUAL VISIT W PPS,25500101,CDM,982,RC,G0439,HCPCS,outpatient,,,273.25,136.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF FALL RISK SCREENING 1100F,25500102,CDM,969,RC,1100F,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF DEPRESSION SCREENING 3725F,25500103,CDM,969,RC,3725F,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF SCREENING DEPRESSION IN ADULTS 15 MIN,25500104,CDM,983,RC,G0444,HCPCS,outpatient,,,22,11,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF INFLUENZA ORDERED OR ADMIN 4037F,25500105,CDM,969,RC,4037F,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF PNEUMOCOCCAL ORDERED OR ADMIN 4040F,25500106,CDM,969,RC,4040F,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF HYPERTENSION PLAN OF CARE 4050F,25500107,CDM,969,RC,4050F,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF TOBACCO SCREEN CESS INTER 4004F,25500108,CDM,969,RC,4004F,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF COGNI IMPAIR DISFUNC ASSESSMENT 3720F,25500109,CDM,969,RC,3720F,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF BMI ABOVE NORMAL W FU PLAN G8417,25500110,CDM,969,RC,G8417,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF OBESITY BEHAVIORAL THERAPY 15MIN,25500111,CDM,983,RC,G0447,HCPCS,outpatient,,,54.5,27.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF ALCOHOL MISUSE SCREEN 15 MIN ANNUAL,25500113,CDM,983,RC,G0442,HCPCS,outpatient,,,22,11,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF BEHAVIORAL COUNS ALCOHOL 15 MIN,25500114,CDM,983,RC,G0443,HCPCS,outpatient,,,54.5,27.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF IPPE WELCOME TO MEDICARE,25500115,CDM,983,RC,G0402,HCPCS,outpatient,,,231.75,115.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF CVD INTENSIVE BEHAVIORA 15 MIN F TO F,25500116,CDM,983,RC,G0446,HCPCS,outpatient,,,54.5,27.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF TRIM TOE ILS,25500127,CDM,983,RC,G0127,HCPCS,outpatient,,,29,14.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF PHYSICIAN CERTIFICATION HH PLAN OF CA,25500180,CDM,983,RC,G0180,HCPCS,outpatient,,,115.75,57.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 10 minutes",25500202,CDM,983,RC,99202,HCPCS,outpatient,,,162,81,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 30 min",25500203,CDM,983,RC,99203,HCPCS,outpatient,,,221.75,110.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 45 min",25500204,CDM,983,RC,99204,HCPCS,outpatient,,,352.75,176.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 60 min",25500205,CDM,983,RC,99205,HCPCS,outpatient,,,464,232,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient not requiring a physician,25500211,CDM,983,RC,99211,HCPCS,outpatient,,,72.75,36.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient requiring a physician,25500212,CDM,983,RC,99212,HCPCS,outpatient,,,112,56,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",25500213,CDM,983,RC,99213,HCPCS,outpatient,,,168,84,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 25 minutes",25500214,CDM,983,RC,99214,HCPCS,outpatient,,,249.5,124.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient, visit typically 40 minutes",25500215,CDM,983,RC,99215,HCPCS,outpatient,,,349.5,174.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF COUNSELING LUNG CANCER SCREEN LDCT,25500296,CDM,983,RC,G0296,HCPCS,outpatient,,,49.75,24.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF REMOVAL OF SUTURES; PHYS OTHER THAN P,25500630,CDM,983,RC,S0630,HCPCS,outpatient,,,43.5,21.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF TH EP MEDICAL DISCUSSION,25502012,CDM,982,RC,G2012,HCPCS,outpatient,,,33.5,16.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 5-10 minutes of medical discussion",25508441,CDM,983,RC,99441,HCPCS,outpatient,,,58.75,29.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 11-20 minutes of medical discussion",25508442,CDM,983,RC,99442,HCPCS,outpatient,,,106.75,53.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 21-30 minutes of medical discussion",25508443,CDM,983,RC,99443,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF TH TRANSITIOL CARE MGMT MOD COMPLEX,25508495,CDM,983,RC,99495,HCPCS,outpatient,,,341.5,170.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF TH TRANSITION CARE MGMT HIGH COMPLEX,25508496,CDM,983,RC,99496,HCPCS,outpatient,,,485,242.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 10 minutes",25508902,CDM,983,RC,99202,HCPCS,outpatient,,,162,81,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 30 min",25508903,CDM,983,RC,99203,HCPCS,outpatient,,,221.75,110.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 45 min",25508904,CDM,983,RC,99204,HCPCS,outpatient,,,352.75,176.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 60 min",25508905,CDM,983,RC,99205,HCPCS,outpatient,,,464,232,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient not requiring a physician,25508911,CDM,983,RC,99211,HCPCS,outpatient,,,72.75,36.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient requiring a physician,25508912,CDM,983,RC,99212,HCPCS,outpatient,,,112,56,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",25508913,CDM,983,RC,99213,HCPCS,outpatient,,,168,84,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 25 minutes",25508914,CDM,983,RC,99214,HCPCS,outpatient,,,249.5,124.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient, visit typically 40 minutes",25508915,CDM,983,RC,99215,HCPCS,outpatient,,,349.5,174.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Incision and draige of abscess; simple or single and complex or multiple,25510060,CDM,983,RC,10060,HCPCS,outpatient,,,242.75,121.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF ABCESS I&D (MULTIPLE OR COMPLEX),25510061,CDM,983,RC,10061,HCPCS,outpatient,,,430,215,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF FOREIGN BODY REMOVAL(SQ SIMPLE),25510120,CDM,983,RC,10120,HCPCS,outpatient,,,236.25,118.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Incision and draige of hematoma, seroma or fluid collection",25510140,CDM,983,RC,10140,HCPCS,outpatient,,,309.25,154.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF VFC HEP B (RECOMBIVAC),25510744,CDM,983,RC,90744,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF DEBRIDEMENT SKIN SUBCUT TISSUE,25511042,CDM,983,RC,11042,HCPCS,outpatient,,,135.25,67.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF PARING CUTTING BEN HYPERKERATOTIC LES,25511055,CDM,983,RC,11055,HCPCS,outpatient,,,69.5,34.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Paring or cutting of benign hyperkeratotic lesion,25511056,CDM,983,RC,11056,HCPCS,outpatient,,,94.75,47.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF PARING CUT BEN HYPERKER LES > 4,25511057,CDM,983,RC,11057,HCPCS,outpatient,,,123.75,61.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Tangential biopsy of skin (e.g., for example, shave, scoop, saucerize, curette); single lesion",25511102,CDM,983,RC,11102,HCPCS,outpatient,,,94.25,47.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Tangential biopsy of skin (e.g., for example, shave, scoop, saucerize, curette); each separate/additiol lesion",25511103,CDM,983,RC,11103,HCPCS,outpatient,,,51,25.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF PUNCH BX SKIN SINGLE LESION,25511104,CDM,983,RC,11104,HCPCS,outpatient,,,118.25,59.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF INCISIOL BX SKIN SINGLE LESION,25511106,CDM,983,RC,11106,HCPCS,outpatient,,,139.75,69.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Removal of skin tags, multiple fibrocutaneous tags, any area",25511200,CDM,983,RC,11200,HCPCS,outpatient,,,169.75,84.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF REMOVAL SKIN TAGS EA ADDTL 10 OR PART,25511201,CDM,983,RC,11201,HCPCS,outpatient,,,48.75,24.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF SHAVE EPID DERMAL LES SINGLE <.5 CM,25511300,CDM,983,RC,11300,HCPCS,outpatient,,,82.25,41.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF SHAVE EPID DERMAL LES SINGLE .6-1.0,25511301,CDM,983,RC,11301,HCPCS,outpatient,,,135.25,67.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF SHAVE EPID DERMAL LES SINGLE 1.1-2.0,25511302,CDM,983,RC,11302,HCPCS,outpatient,,,167,83.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF SHAVE EPID DERMAL LES SINGLE >2.0,25511303,CDM,983,RC,11303,HCPCS,outpatient,,,195.25,97.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF SHAVE EPID DERMAL LES SINGLE <.5 C,25511305,CDM,983,RC,11305,HCPCS,outpatient,,,105.25,52.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF SHAVING EPIDERMAL OR DERMAL LESION .6,25511306,CDM,983,RC,11306,HCPCS,outpatient,,,154.25,77.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF SHAVING EPIDERMAL/DERM LES 1.1-2.0CM,25511307,CDM,983,RC,11307,HCPCS,outpatient,,,179.75,89.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF EXCISION BEN .5 CM OR LESS,25511400,CDM,983,RC,11400,HCPCS,outpatient,,,187,93.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Under Excision-Benign Lesions Procedures on the Skin 0.6-1 CM,25511401,CDM,983,RC,11401,HCPCS,outpatient,,,250.5,125.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF EXCISION BEN 1.1 TO 2.0 CM,25511402,CDM,983,RC,11402,HCPCS,outpatient,,,278.75,139.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF EXCISION BEN 2.1 TO 3.0 CM,25511403,CDM,983,RC,11403,HCPCS,outpatient,,,354.75,177.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF EXCISION BEN 3.1 TO 4.0 CM,25511404,CDM,983,RC,11404,HCPCS,outpatient,,,395.75,197.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF EXCISION BEN > 4.0 CM,25511406,CDM,983,RC,11406,HCPCS,outpatient,,,596.75,298.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF EXCISION BEN LESION <.5 CM,25511440,CDM,983,RC,11440,HCPCS,outpatient,,,240,120,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF EXCISE MALIG LESION <.5CM,25511600,CDM,983,RC,11600,HCPCS,outpatient,,,596.75,298.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF TRIMMING OF NONDYSTROPHIC ILS ANY #,25511719,CDM,983,RC,11719,HCPCS,outpatient,,,33.25,16.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF DEBRIDEMENT IL 1-5,25511720,CDM,983,RC,11720,HCPCS,outpatient,,,51.5,25.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of 6 or more ils,25511721,CDM,983,RC,11721,HCPCS,outpatient,,,85,42.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Separation and removal of the entire il plate or a portion of il plate,25511730,CDM,983,RC,11730,HCPCS,outpatient,,,168.5,84.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF SUBUNGUAL HEMATOMA EVAC,25511740,CDM,983,RC,11740,HCPCS,outpatient,,,84,42,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF IL REMOVAL PART OR COMP,25511750,CDM,983,RC,11750,HCPCS,outpatient,,,451.5,225.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF INSERTION NONBIODEGRADABLE DRUG IMPLA,25511981,CDM,983,RC,11981,HCPCS,outpatient,,,261.25,130.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF REMOVAL NONBIODEGRADABLE DRUG DELIVE,25511982,CDM,983,RC,11982,HCPCS,outpatient,,,275.5,137.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Simple repair of superficial wounds of scalp, neck, axillae, exterl genitalia, trunk and/or extremities",25512001,CDM,983,RC,12001,HCPCS,outpatient,,,196.5,98.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF SIMP RPR SUPERFICIAL WD 2.6 TO 7.5 CM,25512002,CDM,983,RC,12002,HCPCS,outpatient,,,218.25,109.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF SIMP RPR SUPERFICIAL WD 7.5 TO 12.5 C,25512004,CDM,983,RC,12004,HCPCS,outpatient,,,256.25,128.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF SIMP RPR SUPERFICIAL WD 12.6 TO 20.0M,25512005,CDM,983,RC,12005,HCPCS,outpatient,,,319.75,159.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF SIMP RPR SUPERFICIAL WD 20.1 TO 30.0,25512006,CDM,983,RC,12006,HCPCS,outpatient,,,403.5,201.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF LAC REPAIR >30 CM,25512007,CDM,983,RC,12007,HCPCS,outpatient,,,646.5,323.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes",25512011,CDM,983,RC,12011,HCPCS,outpatient,,,203.75,101.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF SIMP RPR FACE 2.6-5 CM,25512013,CDM,983,RC,12013,HCPCS,outpatient,,,231.25,115.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF SIMP RPR SUPERFICIAL WD 5.1 TO 7.5 CM,25512014,CDM,983,RC,12014,HCPCS,outpatient,,,278.75,139.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF SIMP RPR SUPERFICIAL WD 7.6 TO12.5 CM,25512015,CDM,983,RC,12015,HCPCS,outpatient,,,349.5,174.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF SIMP RPR SUPERFICIAL WD 12.6 -20CM,25512016,CDM,983,RC,12016,HCPCS,outpatient,,,427,213.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"FF DEBRIDEMENT, SKIN",25516020,CDM,983,RC,16020,HCPCS,outpatient,,,108.25,54.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of pre-cancerous lesion,25517000,CDM,983,RC,17000,HCPCS,outpatient,,,136,68,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of 2-14 pre-cancerous lesions,25517003,CDM,983,RC,17003,HCPCS,outpatient,,,16.25,8.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF CRYO LESIONS >15,25517004,CDM,983,RC,17004,HCPCS,outpatient,,,343.5,171.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of 1-14 common or plantar warts,25517110,CDM,983,RC,17110,HCPCS,outpatient,,,167.75,83.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of >15 common or plantar warts,25517111,CDM,983,RC,17111,HCPCS,outpatient,,,209.5,104.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF INJECTION CARPAL TUNNEL,25520526,CDM,983,RC,20526,HCPCS,outpatient,,,162.25,81.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Injection of medication into a tendon or ligament,25520550,CDM,983,RC,20550,HCPCS,outpatient,,,86.75,43.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF TRIGGER PT INJ MUS,25520552,CDM,983,RC,20552,HCPCS,outpatient,,,102.75,51.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Injection of medication into an area that triggers pain,25520553,CDM,983,RC,20553,HCPCS,outpatient,,,112.75,56.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a small joint/bursa without ultrasound,25520600,CDM,983,RC,20600,HCPCS,outpatient,,,114,57,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a large joint/bursa without ultrasound,25520605,CDM,983,RC,20605,HCPCS,outpatient,,,92.75,46.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a major joint/bursa without ultrasound,25520610,CDM,983,RC,20610,HCPCS,outpatient,,,112.75,56.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of fluid or injection of medication into a ganglion cyst,25520612,CDM,983,RC,20612,HCPCS,outpatient,,,123.75,61.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF APP LONG ARM CAST,25529105,CDM,983,RC,29105,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF APPLICATION SHORT ARM SPLINT STATIC,25529125,CDM,983,RC,29125,HCPCS,outpatient,,,109,54.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF STRAPPING UN BOOT,25529580,CDM,983,RC,29580,HCPCS,outpatient,,,102,51,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF REMOVAL/BIVALVING GAUNT BOOT,25529700,CDM,983,RC,29700,HCPCS,outpatient,,,100,50,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF REMOVE FOR BODY INTRASAL,25530300,CDM,983,RC,30300,HCPCS,outpatient,,,293.5,146.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF ABLATIN SOFT TISSUE INFERIOR TURBIT,25530801,CDM,983,RC,30801,HCPCS,outpatient,,,317.25,158.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF CAPILLARY BLOOD,25536416,CDM,983,RC,36416,HCPCS,outpatient,,,16.5,8.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF REMOVAL FOREIGN BODY PHARYNX,25542809,CDM,983,RC,42809,HCPCS,outpatient,,,338.25,169.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF EXTERL INCISION HEMORRHOIDS,25546083,CDM,983,RC,46083,HCPCS,outpatient,,,194,97,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF ANOSCOPY DIAG COLLECTION OF SPECIMEN,25546600,CDM,983,RC,46600,HCPCS,outpatient,,,74.75,37.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a small joint/bursa without ultrasound,25550600,CDM,983,RC,20600,HCPCS,outpatient,,,227.75,113.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF BLADDER CATHETER NON DWELL,25551701,CDM,983,RC,51701,HCPCS,outpatient,,,84,42,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF BLADDER CATH SMPLE INDWELLING,25551702,CDM,983,RC,51702,HCPCS,outpatient,,,90.5,45.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF CIRCUMCISION SURG EXCISION,25554160,CDM,983,RC,54160,HCPCS,outpatient,,,426.75,213.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF CIRCUMCISION SURG EXCISION > 28 DAYS,25554161,CDM,983,RC,54161,HCPCS,outpatient,,,640,320,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF ADHESIONS OF PENIS POST CIRCUMCISION,25554162,CDM,983,RC,54162,HCPCS,outpatient,,,567.25,283.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF GS DRAIGE SCROTAL WALL ABSCESS,25555100,CDM,983,RC,55100,HCPCS,outpatient,,,738.75,369.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF INCISION AND DRAIGE VULVA PERINEAL,25556405,CDM,983,RC,56405,HCPCS,outpatient,,,285.5,142.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF BIOPSY OF CERVIX,25557500,CDM,983,RC,57500,HCPCS,outpatient,,,390.5,195.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Biopsy of the lining of the uterus,25558100,CDM,983,RC,58100,HCPCS,outpatient,,,250.75,125.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF IUD INSERTION,25558300,CDM,983,RC,58300,HCPCS,outpatient,,,159,79.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF IUD REMOVAL,25558301,CDM,983,RC,58301,HCPCS,outpatient,,,195.75,97.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF INJ ANESTHETIC AGT OTH PERIPHERAL NE,25564450,CDM,983,RC,64450,HCPCS,outpatient,,,204,102,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF REMOVAL FOR BODY EXT EYE CONJ SUPER,25565205,CDM,983,RC,65205,HCPCS,outpatient,,,111.75,55.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF REMOVAL FOR BODY CORNEAL WO SLIT,25565220,CDM,983,RC,65220,HCPCS,outpatient,,,82.25,41.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF CORRECTION OF TRICHIASIS EPILATION FO,25567820,CDM,983,RC,67820,HCPCS,outpatient,,,138.5,69.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF DRAIN EXT EAR ABSCESS HEMATOMA SIMP,25569000,CDM,983,RC,69000,HCPCS,outpatient,,,296.25,148.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK BIOPSY EXTERL EAR,25569100,CDM,983,RC,69100,HCPCS,outpatient,,,124.25,62.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF FOREIGN BDY REMOVAL AUDITORY CAL,25569200,CDM,983,RC,69200,HCPCS,outpatient,,,110.25,55.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF REMOVAL IMPACTED CERUMEN IRRIG/LAVAGE,25569209,CDM,983,RC,69209,HCPCS,outpatient,,,22.75,11.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of ear wax from one or both ears,25569210,CDM,983,RC,69210,HCPCS,outpatient,,,68.25,34.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF VFC HIB PRPT(HIBERIX) 0.5 ML,25580648,CDM,983,RC,90648,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Hepatitis A vaccition for adolescents and children,25590633,CDM,983,RC,90633,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF VFC HIB PRPT(ACTHIB):0.5 ML,25590648,CDM,983,RC,90648,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
3-dose HPV vaccition,25590649,CDM,983,RC,90649,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF VFC HPV-9 (GARDASIL 9),25590651,CDM,983,RC,90651,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF VFC PCV 13 PNEUMOCOCCAL (PREVR),25590670,CDM,983,RC,90670,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF VFC ROTAVIRUS (ROTATEQ),25590680,CDM,983,RC,90680,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF VFC DTaP/IPV (QUADRACEL) (KINRIX),25590696,CDM,983,RC,90696,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF VFC DTAP/HIB/IPV (PENTACEL),25590698,CDM,983,RC,90698,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF VFC DTaP (DAPTACEL)(INFANRIX),25590700,CDM,983,RC,90700,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Measles, mumps and rubella vaccine",25590707,CDM,983,RC,90707,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"measlesMeasles, mumps, rubella and varicella vaccine",25590710,CDM,983,RC,90710,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF VFC POLIOVIRUS VACCINE (IPV),25590713,CDM,983,RC,90713,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Diphtheria, tetanus acellular, and pertussis vaccine for adults",25590715,CDM,983,RC,90715,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Varicella vaccine,25590716,CDM,983,RC,90716,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF VFC DTAP/HEPB/IPV (PEDIARIX),25590723,CDM,983,RC,90723,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
meningococcal Meningococcal conjugate vaccine,25590734,CDM,983,RC,90734,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF VFC HEP B (ENERGIX B),25590744,CDM,983,RC,90744,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF EKG INTERP,25593010,CDM,983,RC,93010,HCPCS,outpatient,,,25.5,12.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF ECG 1-3 INT AND REPORT,25593042,CDM,983,RC,93042,HCPCS,outpatient,,,32,16,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF CALITH REPOSITIONING MANEUVER,25595992,CDM,983,RC,95992,HCPCS,outpatient,,,137.5,68.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Debridement (for example, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps)",25597597,CDM,983,RC,97597,HCPCS,outpatient,,,70.5,35.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF GLOBAL,25599024,CDM,969,RC,99024,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF EMERGENCY AFTER HRS SERVICE,25599050,CDM,983,RC,99050,HCPCS,outpatient,,,47.25,23.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF EMERGENCY SERVICE-IN OFFICE,25599058,CDM,983,RC,99058,HCPCS,outpatient,,,55.5,27.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF EMERGENCY SERVICE OUT OF OFFICE,25599060,CDM,983,RC,99060,HCPCS,outpatient,,,63.25,31.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF OBSERV DISCHARGE DAY MGMT,25599217,CDM,983,RC,99217,HCPCS,outpatient,,,173.5,86.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF INIT OBS PER DAY LOW COMPLEX,25599218,CDM,983,RC,99218,HCPCS,outpatient,,,165.25,82.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF INIT OBS PER DAY MOD COMPLEX,25599219,CDM,983,RC,99219,HCPCS,outpatient,,,270.75,135.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF INIT OBS PER DAY HIGH COMPLEX,25599220,CDM,983,RC,99220,HCPCS,outpatient,,,377.5,188.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF INIT IP HOSP LOW COMPLEX,25599221,CDM,983,RC,99221,HCPCS,outpatient,,,234.25,117.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF INIT IP HOSP MOD COMPLEXITY,25599222,CDM,983,RC,99222,HCPCS,outpatient,,,318.5,159.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF INIT IP HOSP HIGH COMPLEXITY,25599223,CDM,983,RC,99223,HCPCS,outpatient,,,465.25,232.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF OBS SUB HIGH COMPLEXITY,25599226,CDM,983,RC,99226,HCPCS,outpatient,,,203,101.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF HOME VISIT NEW MOD COMPLEX,25599344,CDM,983,RC,99344,HCPCS,outpatient,,,389.5,194.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF HOME VISIT PROBLEM FOCUSED,25599347,CDM,983,RC,99347,HCPCS,outpatient,,,123.75,61.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF HOME VISIT EXPANDED LOW COMPLEX,25599348,CDM,983,RC,99348,HCPCS,outpatient,,,185.75,92.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF HOME VISIT DETAILED MOD COMPLEXITY,25599349,CDM,983,RC,99349,HCPCS,outpatient,,,271.25,135.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF HOME VISIT COMPREH MOD HIGH COMPLEX,25599350,CDM,983,RC,99350,HCPCS,outpatient,,,378.5,189.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF PROLONGED SERVICES 30-74 MIN,25599354,CDM,983,RC,99354,HCPCS,outpatient,,,205,102.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF PROLONGED SERVICES EA ADDL 30 MIN,25599355,CDM,983,RC,99355,HCPCS,outpatient,,,202.75,101.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial visit for an infant,25599381,CDM,983,RC,99381,HCPCS,outpatient,,,180.25,90.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial visit for new patients 1-4 years old,25599382,CDM,983,RC,99382,HCPCS,outpatient,,,199,99.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
New preventative visit in new patients 5-11 years old,25599383,CDM,983,RC,99383,HCPCS,outpatient,,,199,99.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
New preventative visit in new patients 12-17 years old,25599384,CDM,983,RC,99384,HCPCS,outpatient,,,219.75,109.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial new patient preventive medicine evaluation (18?9 years),25599385,CDM,983,RC,99385,HCPCS,outpatient,,,219.75,109.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial new patient preventive medicine evaluation (40?4 years),25599386,CDM,983,RC,99386,HCPCS,outpatient,,,259.75,129.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial visit for new patients 65 and older years old,25599387,CDM,983,RC,99387,HCPCS,outpatient,,,280.75,140.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Periodic primary re-evaluation for an established infant patient,25599391,CDM,983,RC,99391,HCPCS,outpatient,,,158.5,79.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial visit for new patients 1-4 years old,25599392,CDM,983,RC,99392,HCPCS,outpatient,,,180,90,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
New preventative visit in new patients 5-11 years old,25599393,CDM,983,RC,99393,HCPCS,outpatient,,,180,90,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
New preventative visit in new patients 12-17 years old,25599394,CDM,983,RC,99394,HCPCS,outpatient,,,198.75,99.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Established patient periodic preventive medicine examition age 18-39 years,25599395,CDM,983,RC,99395,HCPCS,outpatient,,,198.75,99.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Established patient periodic preventive medicine examition age 40-64 years,25599396,CDM,983,RC,99396,HCPCS,outpatient,,,219.5,109.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Periodic primary re-evaluation for an established patient 65 and older,25599397,CDM,983,RC,99397,HCPCS,outpatient,,,240.25,120.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF ESTAB PT PREV COUNSEL 15 MIN,25599401,CDM,983,RC,99401,HCPCS,outpatient,,,54.5,27.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF NEW/ESTAB PT PREV COUNSEL 30 MIN,25599402,CDM,983,RC,99402,HCPCS,outpatient,,,111.5,55.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF NEW/ESTAB PT PREV COUNSEL 45 MIN,25599403,CDM,983,RC,99403,HCPCS,outpatient,,,166.25,83.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF NEW/ESTAB PT PREV COUNSEL 60 MIN,25599404,CDM,983,RC,99404,HCPCS,outpatient,,,221.5,110.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF TOBACCO COUNSEL 3-10 MIN,25599406,CDM,983,RC,99406,HCPCS,outpatient,,,27.25,13.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF SMOKING COUNSEL>10 MIN,25599407,CDM,983,RC,99407,HCPCS,outpatient,,,54.5,27.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF ALCOHOL/SUB ABUSE SCREEN 15-30 MIN,25599408,CDM,983,RC,99408,HCPCS,outpatient,,,72.75,36.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF ALCOHOL/SUB ABUSE SCREEN >30 MIN,25599409,CDM,983,RC,99409,HCPCS,outpatient,,,146.25,73.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF UNLISTED PREVENTATIVE SCHOOL PHYSICAL,25599429,CDM,983,RC,99429,HCPCS,outpatient,,,25,12.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 5-10 minutes of medical discussion",25599441,CDM,983,RC,99441,HCPCS,outpatient,,,31,15.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 11-20 minutes of medical discussion",25599442,CDM,983,RC,99442,HCPCS,outpatient,,,59.25,29.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 21-30 minutes of medical discussion",25599443,CDM,983,RC,99443,HCPCS,outpatient,,,86.25,43.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF DHHR PHYSICAL,25599450,CDM,983,RC,99450,HCPCS,outpatient,,,263,131.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF DISABILITY EXAMITION,25599455,CDM,983,RC,99455,HCPCS,outpatient,,,263,131.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF DISABILITY EXAM-NOT TREATING MD,25599456,CDM,983,RC,99456,HCPCS,outpatient,,,263,131.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF TRANSITIOL CARE MGMT MOD COMPLEX,25599495,CDM,983,RC,99495,HCPCS,outpatient,,,341.5,170.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF TRANSITIOL CARE MGMT HIGH COMPLEX,25599496,CDM,983,RC,99496,HCPCS,outpatient,,,485,242.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF CHRONIC CARE MGMT 20 MIN,25599990,CDM,983,RC,99490,HCPCS,outpatient,,,82.75,41.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF CHRONIC CARE MGMT PRO 60 MIN,25599991,CDM,983,RC,99487,HCPCS,outpatient,,,180.5,90.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF CHRONIC CARE MGMT PRO EA ADD 30,25599992,CDM,983,RC,99489,HCPCS,outpatient,,,90.75,45.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FF CHRONIC CARE MGMT CMP ASSESSMENT,25599995,CDM,983,RC,G0506,HCPCS,outpatient,,,105.25,52.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient not requiring a physician,25599997,CDM,983,RC,99211,HCPCS,outpatient,,,100,50,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK WELLNESS INITIAL ANNUAL VISIT W PPS,25600100,CDM,982,RC,G0438,HCPCS,outpatient,,,329,164.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK WELLNESS SUBSEQ  ANNUAL VISIT W PPS,25600101,CDM,982,RC,G0439,HCPCS,outpatient,,,273.25,136.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK FALL RISK SCREENING 1100F,25600102,CDM,969,RC,1100F,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK DEPRESSION SCREENING 3725F,25600103,CDM,969,RC,3725F,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK SCREENING DEPRESSION IN ADULTS 15 MIN,25600104,CDM,983,RC,G0444,HCPCS,outpatient,,,22,11,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK INFLUENZA ORDERED OR ADMIN 4037F,25600105,CDM,969,RC,4037F,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK PNEUMOCOCCAL ORDERED OR ADMIN 4040F,25600106,CDM,969,RC,4040F,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK HYPERTENSION PLAN OF CARE 4050F,25600107,CDM,969,RC,4050F,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK TOBACCO SCREEN CESS INTER 4004F,25600108,CDM,969,RC,4004F,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK COGNI IMPAIR DISFUNC ASSESSMENT 3720F,25600109,CDM,969,RC,3720F,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK BMI ABOVE NORMAL W FU PLAN G8417,25600110,CDM,969,RC,G8417,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK OBESITY BEHAVIORAL THERAPY 15MIN,25600111,CDM,983,RC,G0447,HCPCS,outpatient,,,54.5,27.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK ALCOHOL MISUSE SCREEN 15 MIN ANNUAL,25600113,CDM,983,RC,G0442,HCPCS,outpatient,,,22,11,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK BEHAVIORAL COUNS ALCOHOL 15 MIN,25600114,CDM,983,RC,G0443,HCPCS,outpatient,,,54.5,27.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK IPPE WELCOME TO MEDICARE,25600115,CDM,983,RC,G0402,HCPCS,outpatient,,,231.75,115.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK CVD INTENSIVE BEHAVIORA 15 MIN F TO F,25600116,CDM,983,RC,G0446,HCPCS,outpatient,,,54.5,27.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TF TRIM TOE ILS,25600127,CDM,983,RC,G0127,HCPCS,outpatient,,,29,14.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK COUNSELING LUNG CANCER SCREEN LDCT,25600296,CDM,983,RC,G0296,HCPCS,outpatient,,,49.75,24.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK REMOVAL OF SUTURES PHYSICIAN OTHER TH,25600630,CDM,983,RC,S0630,HCPCS,outpatient,,,43.5,21.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 5-10 minutes of medical discussion",25608441,CDM,983,RC,99441,HCPCS,outpatient,,,58.75,29.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 11-20 minutes of medical discussion",25608442,CDM,983,RC,99442,HCPCS,outpatient,,,106.75,53.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 21-30 minutes of medical discussion",25608443,CDM,983,RC,99443,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK TH TRANSITIOL CARE MGMT MOD COMPLEX,25608495,CDM,983,RC,99495,HCPCS,outpatient,,,341.5,170.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK TH TRANSITION CARE MGMT HIGH COMPLEX,25608496,CDM,983,RC,99496,HCPCS,outpatient,,,485,242.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 10 minutes",25608902,CDM,983,RC,99202,HCPCS,outpatient,,,107,53.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 30 min",25608903,CDM,983,RC,99203,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 45 min",25608904,CDM,983,RC,99204,HCPCS,outpatient,,,265,132.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 60 min",25608905,CDM,983,RC,99205,HCPCS,outpatient,,,343.5,171.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient not requiring a physician,25608911,CDM,983,RC,99211,HCPCS,outpatient,,,24.5,12.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient requiring a physician,25608912,CDM,983,RC,99212,HCPCS,outpatient,,,56.5,28.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",25608913,CDM,983,RC,99213,HCPCS,outpatient,,,106.25,53.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 25 minutes",25608914,CDM,983,RC,99214,HCPCS,outpatient,,,162,81,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient, visit typically 40 minutes",25608915,CDM,983,RC,99215,HCPCS,outpatient,,,228.75,114.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Incision and draige of abscess; simple or single and complex or multiple,25610060,CDM,983,RC,10060,HCPCS,outpatient,,,242.75,121.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TF DEBRIDEMENT SKIN SUBCUT TISSUE,25611042,CDM,983,RC,11042,HCPCS,outpatient,,,135.25,67.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Tangential biopsy of skin (e.g., for example, shave, scoop, saucerize, curette); single lesion",25611102,CDM,983,RC,11102,HCPCS,outpatient,,,94.25,47.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK PUNCH BX SKIN SINGLE LESION,25611104,CDM,983,RC,11104,HCPCS,outpatient,,,118.25,59.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Removal of skin tags, multiple fibrocutaneous tags, any area",25611200,CDM,983,RC,11200,HCPCS,outpatient,,,169.75,84.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK REMOVAL SKIN TAGS EA ADDTL 10 OR PART,25611201,CDM,983,RC,11201,HCPCS,outpatient,,,48.75,24.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Under Excision-Benign Lesions Procedures on the Skin 0.6-1 CM,25611401,CDM,983,RC,11401,HCPCS,outpatient,,,250.5,125.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TF INSERTION NONBIODEGRADABLE DRUG IMPLA,25611981,CDM,983,RC,11981,HCPCS,outpatient,,,261.25,130.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FK REMOVAL NONBIODEGRADABLE DRUG DELIVE,25611982,CDM,983,RC,11982,HCPCS,outpatient,,,275.5,137.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of pre-cancerous lesion,25617000,CDM,983,RC,17000,HCPCS,outpatient,,,136,68,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of 2-14 pre-cancerous lesions,25617003,CDM,983,RC,17003,HCPCS,outpatient,,,16.25,8.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK CRYO LESIONS >15,25617004,CDM,983,RC,17004,HCPCS,outpatient,,,343.5,171.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of 1-14 common or plantar warts,25617110,CDM,983,RC,17110,HCPCS,outpatient,,,167.75,83.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of >15 common or plantar warts,25617111,CDM,983,RC,17111,HCPCS,outpatient,,,209.5,104.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a small joint/bursa without ultrasound,25620600,CDM,983,RC,20600,HCPCS,outpatient,,,114,57,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a large joint/bursa without ultrasound,25620605,CDM,983,RC,20605,HCPCS,outpatient,,,92.75,46.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a major joint/bursa without ultrasound,25620610,CDM,983,RC,20610,HCPCS,outpatient,,,112.75,56.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK IUD INSERTION,25658300,CDM,983,RC,58300,HCPCS,outpatient,,,159,79.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK IUD REMOVAL,25658301,CDM,983,RC,58301,HCPCS,outpatient,,,195.75,97.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TF FOREIGN BODY REMOVAL AUDITORY CAL,25669200,CDM,983,RC,69200,HCPCS,outpatient,,,110.25,55.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of ear wax from one or both ears,25669210,CDM,983,RC,69210,HCPCS,outpatient,,,68.25,34.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TF VFC DTaP/IPV (QUADRACEL) (KINRIX),25690696,CDM,983,RC,90696,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK EKG INTERP,25693010,CDM,983,RC,93010,HCPCS,outpatient,,,25.5,12.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 10 minutes",25699202,CDM,983,RC,99202,HCPCS,outpatient,,,107,53.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 30 min",25699203,CDM,983,RC,99203,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 45 min",25699204,CDM,983,RC,99204,HCPCS,outpatient,,,265,132.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 60 min",25699205,CDM,983,RC,99205,HCPCS,outpatient,,,343.5,171.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient not requiring a physician,25699211,CDM,983,RC,99211,HCPCS,outpatient,,,24.5,12.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient requiring a physician,25699212,CDM,983,RC,99212,HCPCS,outpatient,,,56.5,28.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",25699213,CDM,983,RC,99213,HCPCS,outpatient,,,106.25,53.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 25 minutes",25699214,CDM,983,RC,99214,HCPCS,outpatient,,,162,81,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient, visit typically 40 minutes",25699215,CDM,983,RC,99215,HCPCS,outpatient,,,228.75,114.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TF NURSING FACILITY INITIAL LOW COMPLEX,25699304,CDM,983,RC,99304,HCPCS,outpatient,,,210.25,105.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TF NURSING FACILITY INITIAL MOD COMPLEX,25699305,CDM,983,RC,99305,HCPCS,outpatient,,,294.25,147.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TF NURSING FACILITY INITIAL HIGH COMPLEX,25699306,CDM,983,RC,99306,HCPCS,outpatient,,,378.25,189.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK NURS FAC SUB CARE STRAIGHT FORWARD,25699307,CDM,983,RC,99307,HCPCS,outpatient,,,104.5,52.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK NURS FAC SUB CARE LOW COMPLEX,25699308,CDM,983,RC,99308,HCPCS,outpatient,,,158.25,79.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK NURS FAC SUB CARE MOD COMPLEX,25699309,CDM,983,RC,99309,HCPCS,outpatient,,,210.5,105.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK NURS FAC SUB CARE HIGH COMPLEX,25699310,CDM,983,RC,99310,HCPCS,outpatient,,,310.5,155.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK NURS FAC DISCHARGE > 30 MIN,25699315,CDM,983,RC,99315,HCPCS,outpatient,,,152.75,76.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK NURS FAC DISCHARGE > 30 MIN,25699316,CDM,983,RC,99316,HCPCS,outpatient,,,199,99.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK NURS FAC ANNUAL EXAM LOW TO MOD,25699318,CDM,983,RC,99318,HCPCS,outpatient,,,220,110,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TF NP DOMICILIARY E/M STRAIGHTFORWARD,25699324,CDM,982,RC,99324,HCPCS,outpatient,,,98.75,49.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TF NP DOMICILIARY E/M EXPAND PROB FOCUS,25699325,CDM,982,RC,99325,HCPCS,outpatient,,,143.5,71.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TF NP DOMICILIARY E/M DETAIL MOD COMPLEX,25699326,CDM,982,RC,99326,HCPCS,outpatient,,,249.75,124.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TF NP DOMICILIARY E/M COMPRE MOD COMPLEX,25699327,CDM,982,RC,99327,HCPCS,outpatient,,,335.5,167.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TF NP DOMICILIARY E/M HIGH COMPLEXITY,25699328,CDM,982,RC,99328,HCPCS,outpatient,,,396.75,198.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TF EP DOMICILIARY E/M STRAIGHTFORWARD,25699334,CDM,982,RC,99334,HCPCS,outpatient,,,109,54.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TF EP DOMICILIARY E/M EXPANDED PROB FOCU,25699335,CDM,982,RC,99335,HCPCS,outpatient,,,172.5,86.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TF EP DOMICILIARY E/M MOD COMPLEXITY,25699336,CDM,982,RC,99336,HCPCS,outpatient,,,243.25,121.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TF EP DOMICILIARY E/M MOD HIGH COMPLEXIT,25699337,CDM,982,RC,99337,HCPCS,outpatient,,,350.75,175.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK HOME VISIT PROBLEM FOCUSED,25699347,CDM,983,RC,99347,HCPCS,outpatient,,,123.75,61.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK HOME VISIT EXPANDED LOW COMPLEX,25699348,CDM,983,RC,99348,HCPCS,outpatient,,,185.75,92.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK HOME VISIT DETAILED MOD COMPLEXITY,25699349,CDM,983,RC,99349,HCPCS,outpatient,,,271.25,135.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK HOME VISIT COMPREH MOD HIGH COMPLEX,25699350,CDM,983,RC,99350,HCPCS,outpatient,,,378.5,189.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial visit for an infant,25699381,CDM,983,RC,99381,HCPCS,outpatient,,,140,70,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial visit for new patients 1-4 years old,25699382,CDM,983,RC,99382,HCPCS,outpatient,,,159,79.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
New preventative visit in new patients 5-11 years old,25699383,CDM,983,RC,99383,HCPCS,outpatient,,,159,79.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
New preventative visit in new patients 12-17 years old,25699384,CDM,983,RC,99384,HCPCS,outpatient,,,179.75,89.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial new patient preventive medicine evaluation (18?9 years),25699385,CDM,983,RC,99385,HCPCS,outpatient,,,179.75,89.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial new patient preventive medicine evaluation (40?4 years),25699386,CDM,983,RC,99386,HCPCS,outpatient,,,220,110,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial visit for new patients 65 and older years old,25699387,CDM,983,RC,99387,HCPCS,outpatient,,,240.75,120.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Periodic primary re-evaluation for an established infant patient,25699391,CDM,983,RC,99391,HCPCS,outpatient,,,119.75,59.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial visit for new patients 1-4 years old,25699392,CDM,983,RC,99392,HCPCS,outpatient,,,140,70,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
New preventative visit in new patients 5-11 years old,25699393,CDM,983,RC,99393,HCPCS,outpatient,,,140,70,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
New preventative visit in new patients 12-17 years old,25699394,CDM,983,RC,99394,HCPCS,outpatient,,,159,79.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Established patient periodic preventive medicine examition age 18-39 years,25699395,CDM,983,RC,99395,HCPCS,outpatient,,,159,79.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Established patient periodic preventive medicine examition age 40-64 years,25699396,CDM,983,RC,99396,HCPCS,outpatient,,,179.75,89.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Periodic primary re-evaluation for an established patient 65 and older,25699397,CDM,983,RC,99397,HCPCS,outpatient,,,200.75,100.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TF TOBACCO COUNSELING  3-10 MIN,25699406,CDM,983,RC,99406,HCPCS,outpatient,,,27.25,13.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TF SCHOOL OR SPORTS PHYSICAL PRIVATE PAY,25699429,CDM,983,RC,99429,HCPCS,outpatient,,,25,12.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK TRANSITIOL CARE MGMT MOD COMPLEX,25699495,CDM,983,RC,99495,HCPCS,outpatient,,,341.5,170.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
TK TRANSITIOL CARE MGMT HIGH COMPLEX,25699496,CDM,983,RC,99496,HCPCS,outpatient,,,485,242.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MS FALL RISK SCREENING 1100F,25700102,CDM,969,RC,1100F,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MS DEPRESSION SCREENING 3725F,25700103,CDM,969,RC,3725F,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MS HYPERTENSION PLAN OF CARE 4050F,25700107,CDM,969,RC,4050F,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MS TOBACCO SCREEN CESS INTER 4004F,25700108,CDM,969,RC,4004F,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MS COGNI IMPAIR DISFUNC ASSESSMENT 3720F,25700109,CDM,969,RC,3720F,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MS BMI ABOVE NORMAL W FU PLAN G8417,25700110,CDM,969,RC,G8417,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MS OBESITY BEHAVIORAL THERAPY 15MIN,25700111,CDM,983,RC,G0447,HCPCS,outpatient,,,54.5,27.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MS ALCOHOL MISUSE SCREEN 15 MIN ANNUAL,25700113,CDM,983,RC,G0442,HCPCS,outpatient,,,22,11,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MS BEHAVIORAL COUNS ALCOHOL 15 MIN,25700114,CDM,983,RC,G0443,HCPCS,outpatient,,,54.5,27.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MS IPPE WELCOME TO MEDICARE,25700115,CDM,983,RC,G0402,HCPCS,outpatient,,,231.75,115.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MS CVD INTENSIVE BEHAVIORA 15 MIN F TO F,25700116,CDM,983,RC,G0446,HCPCS,outpatient,,,54.5,27.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MS COUNSELING LUNG CANCER SCREEN LDCT,25700296,CDM,983,RC,G0296,HCPCS,outpatient,,,49.75,24.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MS WELLNESS INITIAL ANNUAL VISIT W PPS,25700438,CDM,982,RC,G0438,HCPCS,outpatient,,,329,164.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MS WELLNESS SUBSEQ  ANNUAL VISIT W PPS,25700439,CDM,982,RC,G0439,HCPCS,outpatient,,,273.25,136.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MS REMOVAL OF SUTURES PHYSICIAN OTHER TH,25700630,CDM,983,RC,S0630,HCPCS,outpatient,,,43.5,21.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 10 minutes",25708902,CDM,983,RC,99202,HCPCS,outpatient,,,107,53.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 30 min",25708903,CDM,983,RC,99203,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 45 min",25708904,CDM,983,RC,99204,HCPCS,outpatient,,,265,132.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 60 min",25708905,CDM,983,RC,99205,HCPCS,outpatient,,,343.5,171.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient not requiring a physician,25708911,CDM,983,RC,99211,HCPCS,outpatient,,,24.5,12.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient requiring a physician,25708912,CDM,983,RC,99212,HCPCS,outpatient,,,56.5,28.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",25708913,CDM,983,RC,99213,HCPCS,outpatient,,,106.25,53.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 25 minutes",25708914,CDM,983,RC,99214,HCPCS,outpatient,,,162,81,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient, visit typically 40 minutes",25708915,CDM,983,RC,99215,HCPCS,outpatient,,,228.75,114.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a major joint/bursa without ultrasound,25720610,CDM,983,RC,20610,HCPCS,outpatient,,,112.75,56.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of ear wax from one or both ears,25769210,CDM,983,RC,69210,HCPCS,outpatient,,,68.25,34.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MS EKG INTERP,25793010,CDM,983,RC,93010,HCPCS,outpatient,,,25.5,12.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 10 minutes",25799202,CDM,983,RC,99202,HCPCS,outpatient,,,107,53.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 30 min",25799203,CDM,983,RC,99203,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 45 min",25799204,CDM,983,RC,99204,HCPCS,outpatient,,,265,132.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 60 min",25799205,CDM,983,RC,99205,HCPCS,outpatient,,,343.5,171.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient not requiring a physician,25799211,CDM,983,RC,99211,HCPCS,outpatient,,,24.5,12.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient requiring a physician,25799212,CDM,983,RC,99212,HCPCS,outpatient,,,56.5,28.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",25799213,CDM,983,RC,99213,HCPCS,outpatient,,,106.25,53.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 25 minutes",25799214,CDM,983,RC,99214,HCPCS,outpatient,,,162,81,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient, visit typically 40 minutes",25799215,CDM,983,RC,99215,HCPCS,outpatient,,,228.75,114.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MS NURSING FACILITY INITIAL HIGH COMPLEX,25799306,CDM,983,RC,99306,HCPCS,outpatient,,,378.25,189.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MS NURS FAC SUB CARE STRAIGHT FORWARD,25799307,CDM,983,RC,99307,HCPCS,outpatient,,,104.5,52.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MS NURS FAC SUB CARE LOW COMPLEX,25799308,CDM,983,RC,99308,HCPCS,outpatient,,,158.25,79.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MS NURS FAC SUB CARE MOD COMPLEX,25799309,CDM,983,RC,99309,HCPCS,outpatient,,,210.5,105.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial visit for an infant,25799381,CDM,983,RC,99381,HCPCS,outpatient,,,140,70,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial visit for new patients 1-4 years old,25799382,CDM,983,RC,99382,HCPCS,outpatient,,,159,79.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
New preventative visit in new patients 5-11 years old,25799383,CDM,983,RC,99383,HCPCS,outpatient,,,159,79.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
New preventative visit in new patients 12-17 years old,25799384,CDM,983,RC,99384,HCPCS,outpatient,,,179.75,89.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial new patient preventive medicine evaluation (18?9 years),25799385,CDM,983,RC,99385,HCPCS,outpatient,,,179.75,89.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial new patient preventive medicine evaluation (40?4 years),25799386,CDM,983,RC,99386,HCPCS,outpatient,,,220,110,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial visit for new patients 65 and older years old,25799387,CDM,983,RC,99387,HCPCS,outpatient,,,240.75,120.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Periodic primary re-evaluation for an established infant patient,25799391,CDM,983,RC,99391,HCPCS,outpatient,,,119.75,59.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial visit for new patients 1-4 years old,25799392,CDM,983,RC,99392,HCPCS,outpatient,,,140,70,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
New preventative visit in new patients 5-11 years old,25799393,CDM,983,RC,99393,HCPCS,outpatient,,,140,70,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
New preventative visit in new patients 12-17 years old,25799394,CDM,983,RC,99394,HCPCS,outpatient,,,159,79.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Established patient periodic preventive medicine examition age 18-39 years,25799395,CDM,983,RC,99395,HCPCS,outpatient,,,159,79.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Established patient periodic preventive medicine examition age 40-64 years,25799396,CDM,983,RC,99396,HCPCS,outpatient,,,179.75,89.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Periodic primary re-evaluation for an established patient 65 and older,25799397,CDM,983,RC,99397,HCPCS,outpatient,,,200.75,100.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MS TRANSITIOL CARE MGMT MOD COMPLEX,25799495,CDM,983,RC,99495,HCPCS,outpatient,,,341.5,170.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
MS TRANSITIOL CARE MGMT HIGH COMPLEX,25799496,CDM,983,RC,99496,HCPCS,outpatient,,,485,242.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Immunization administration by a medical assistant or nurse,26000005,CDM,983,RC,90471,HCPCS,outpatient,,,23.75,11.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FM VFC VACCINE ADMINISTRATION EA ADDL,26000006,CDM,983,RC,90472,HCPCS,outpatient,,,23.75,11.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
P. Collingwood,26000025,CDM,983,RC,99024,HCPCS,outpatient,,,19,9.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
STAFF TB MCA,26000030,CDM,983,RC,99024,HCPCS,outpatient,,,41.5,20.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FM REMOVAL OF SUTURES PHYSICIAN OTHER TH,26000630,CDM,983,RC,S0630,HCPCS,outpatient,,,43.5,21.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Diphtheria, tetanus acellular, and pertussis vaccine for adults",26000715,CDM,983,RC,90715,HCPCS,outpatient,,,380.25,190.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Incision and draige of abscess; simple or single and complex or multiple,26010060,CDM,983,RC,10060,HCPCS,outpatient,,,242.75,121.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FM ABCESS I&D (MULTIPLE OR COMPLEX),26010061,CDM,983,RC,10061,HCPCS,outpatient,,,430,215,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Incision and draige of hematoma, seroma or fluid collection",26010140,CDM,983,RC,10140,HCPCS,outpatient,,,417.75,208.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FM VFC HEP B (RECOMBIVAC),26010744,CDM,983,RC,90744,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FM EXCISION BEN 0.5 CM OR LESS,26011400,CDM,983,RC,11400,HCPCS,outpatient,,,187,93.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FM TRIMMING OF NONDYSTROPHIC ILS ANY #,26011719,CDM,983,RC,11719,HCPCS,outpatient,,,33.25,16.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Separation and removal of the entire il plate or a portion of il plate,26011730,CDM,983,RC,11730,HCPCS,outpatient,,,168.5,84.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FM AVULSION IL PLATE; EA ADDT'L,26011732,CDM,983,RC,11732,HCPCS,outpatient,,,71.75,35.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FM IL REMOVAL PART OR COMP,26011750,CDM,983,RC,11750,HCPCS,outpatient,,,451.5,225.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FM INSERTION NONBIODEGRADABLE DRUG IMPLA,26011981,CDM,983,RC,11981,HCPCS,outpatient,,,261.25,130.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FM REMOVAL NONBIODEGRADABLE DRUG DELIVE,26011982,CDM,983,RC,11982,HCPCS,outpatient,,,275.5,137.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Simple repair of superficial wounds of scalp, neck, axillae, exterl genitalia, trunk and/or extremities",26012001,CDM,983,RC,12001,HCPCS,outpatient,,,196.5,98.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of pre-cancerous lesion,26017000,CDM,983,RC,17000,HCPCS,outpatient,,,136,68,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of 2-14 pre-cancerous lesions,26017003,CDM,983,RC,17003,HCPCS,outpatient,,,16.25,8.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of 1-14 common or plantar warts,26017110,CDM,983,RC,17110,HCPCS,outpatient,,,167.75,83.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of >15 common or plantar warts,26017111,CDM,983,RC,17111,HCPCS,outpatient,,,209.5,104.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FM INTERPHALANGEAL DIS,26026770,CDM,983,RC,26770,HCPCS,outpatient,,,633,316.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FM CONTROL SAL HEMORRHAGE ANTERIOR COM,26030903,CDM,983,RC,30903,HCPCS,outpatient,,,247,123.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FM ADHESIONS OF PENIS POST CIRCUMCISION,26054162,CDM,983,RC,54162,HCPCS,outpatient,,,567.25,283.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FM INCISION AND DRAIGE VULVA PERINEAL,26056405,CDM,983,RC,56405,HCPCS,outpatient,,,285.5,142.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FM DRAIN EXT EAR ABSCESS HEMATOMA SIMP,26069000,CDM,983,RC,69000,HCPCS,outpatient,,,296.25,148.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FM REMOVAL IMPACTED CERUMEN IRRIG/LAVAGE,26069209,CDM,983,RC,69209,HCPCS,outpatient,,,22.75,11.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of ear wax from one or both ears,26069210,CDM,983,RC,69210,HCPCS,outpatient,,,68.25,34.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Diphtheria, tetanus acellular, and pertussis vaccine for adults",26090715,CDM,983,RC,90715,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FM EKG INTERP,26093010,CDM,983,RC,93010,HCPCS,outpatient,,,25.5,12.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Debridement (for example, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps)",26097597,CDM,983,RC,97597,HCPCS,outpatient,,,70.5,35.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FM GLOBAL,26099024,CDM,969,RC,99024,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 10 minutes",26099202,CDM,983,RC,99202,HCPCS,outpatient,,,107,53.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 30 min",26099203,CDM,983,RC,99203,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 45 min",26099204,CDM,983,RC,99204,HCPCS,outpatient,,,265,132.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 60 min",26099205,CDM,983,RC,99205,HCPCS,outpatient,,,343.5,171.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient not requiring a physician,26099211,CDM,983,RC,99211,HCPCS,outpatient,,,24.5,12.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient requiring a physician,26099212,CDM,983,RC,99212,HCPCS,outpatient,,,56.5,28.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",26099213,CDM,983,RC,99213,HCPCS,outpatient,,,106.25,53.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 25 minutes",26099214,CDM,983,RC,99214,HCPCS,outpatient,,,162,81,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient, visit typically 40 minutes",26099215,CDM,983,RC,99215,HCPCS,outpatient,,,228.75,114.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
New preventative visit in new patients 12-17 years old,26099384,CDM,983,RC,99384,HCPCS,outpatient,,,179.75,89.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial new patient preventive medicine evaluation (18?9 years),26099385,CDM,983,RC,99385,HCPCS,outpatient,,,179.75,89.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
New preventative visit in new patients 12-17 years old,26099394,CDM,983,RC,99394,HCPCS,outpatient,,,159,79.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Established patient periodic preventive medicine examition age 18-39 years,26099395,CDM,983,RC,99395,HCPCS,outpatient,,,159,79.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FM UNLISTED PREVENTATIVE SCHOOL PHYSICAL,26099429,CDM,983,RC,99429,HCPCS,outpatient,,,25,12.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
FM UNLISTED SCHOOL PHYSICAL,26099499,CDM,983,RC,99499,HCPCS,outpatient,,,25,12.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",26508913,CDM,983,RC,99213,HCPCS,outpatient,,,106.25,53.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"BLADDER IRRIGATION, SPL LAVAGE A/O I",26551700,CDM,983,RC,51700,HCPCS,outpatient,,,83.25,41.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UR INSERT NON-INDWELLING BLADDER CATH,26551701,CDM,983,RC,51701,HCPCS,outpatient,,,191.75,95.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
INSERT TEMP BLADDER CATH,26551702,CDM,983,RC,51702,HCPCS,outpatient,,,237.5,118.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CATH INDWELLING COMPLEX,26551703,CDM,981,RC,51703,HCPCS,outpatient,,,450,225,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CHANGE CYSTOSTOMY TUBE,26551705,CDM,981,RC,51705,HCPCS,outpatient,,,351.75,175.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CHANGE OF CYSTOTOMY TUBE COMP,26551710,CDM,983,RC,51710,HCPCS,outpatient,,,287.75,143.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
BLADDER INSTALLATION OF ANTICARCINOGENIC,26551720,CDM,983,RC,51720,HCPCS,outpatient,,,261.5,130.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
COMPLEX CMG PRO FEE ONLY,26551726,CDM,983,RC,51726,HCPCS,outpatient,,,305.5,152.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
COMPLEX CMG W URETH PROF PRO FEE ONL,26551727,CDM,983,RC,51727,HCPCS,outpatient,,,358.75,179.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
COMPLEX CMG W VOIDING PR PRO FEE ONL,26551728,CDM,983,RC,51728,HCPCS,outpatient,,,353.75,176.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
COMPLEX CMG W VOIDING URETH PRES PRO,26551729,CDM,983,RC,51729,HCPCS,outpatient,,,417,208.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
A diagnostic test used to measure the flow of urine,26551741,CDM,983,RC,51741,HCPCS,outpatient,,,205.25,102.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Procedure on the bladder,26552000,CDM,983,RC,52000,HCPCS,outpatient,,,275.75,137.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UR CYSTOURETHROSCOPY W URETERAL CATH W/W,26552005,CDM,983,RC,52005,HCPCS,outpatient,,,442,221,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UR CYSTOURETHROSCOPY W BIOPSY,26552204,CDM,983,RC,52204,HCPCS,outpatient,,,469,234.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CYSTOURETHROSCOPY W FULGURATION TRIGONE,26552214,CDM,983,RC,52214,HCPCS,outpatient,,,696.25,348.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CYSTOURETHROSCOPY W CALIB,26552281,CDM,983,RC,52281,HCPCS,outpatient,,,1093,546.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removing an indwelling ureteral stent by cystoscopy,26552310,CDM,983,RC,52310,HCPCS,outpatient,,,473,236.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CYSTOURETHROSCOPY W REMOV FB COMPLEX,26552315,CDM,983,RC,52315,HCPCS,outpatient,,,857,428.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
DILATION URETHRAL STRICTURE BY SOUND IN,26553600,CDM,983,RC,53600,HCPCS,outpatient,,,202.75,101.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
DILATION URETHRAL STRICTURE BY SOUND SUB,26553601,CDM,983,RC,53601,HCPCS,outpatient,,,168.25,84.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UR SLITTING PREPUCE DORSAL/LATER NOT NB,26554001,CDM,983,RC,54001,HCPCS,outpatient,,,392.25,196.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UR CIRCUMCISION SURG NOT CLAMP DEV D SLI,26554161,CDM,983,RC,54161,HCPCS,outpatient,,,438.5,219.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of sperm duct(s),26555250,CDM,983,RC,55250,HCPCS,outpatient,,,566.5,283.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UR EXCISION HYDROCELE SPERM CORD UNI,26555500,CDM,983,RC,55500,HCPCS,outpatient,,,1108,554,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Biopsy of prostate gland,26555700,CDM,983,RC,55700,HCPCS,outpatient,,,450.75,225.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UR TRANSURETHRAL BX PROSTATE W/ CYSTOSCO,26555899,CDM,983,RC,55899,HCPCS,outpatient,,,421.25,210.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
URO COLPOSCOPY VAGI W/CERVIX,26557420,CDM,983,RC,57420,HCPCS,outpatient,,,364.5,182.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
COLPOSCOPY CERVIX INC UPPER ADJ,26557452,CDM,983,RC,57452,HCPCS,outpatient,,,400,200,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Transrectal ultrasound,26576872,CDM,972,RC,76872,HCPCS,outpatient,,,143.25,71.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UR US GUIDE FOR NEEDLE PLACEMENT,26576942,CDM,983,RC,76942,HCPCS,outpatient,,,138,69,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
URO GLOBAL,26599024,CDM,969,RC,99024,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 10 minutes",26599202,CDM,983,RC,99202,HCPCS,outpatient,,,107,53.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 30 min",26599203,CDM,983,RC,99203,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 45 min",26599204,CDM,983,RC,99204,HCPCS,outpatient,,,265,132.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 60 min",26599205,CDM,983,RC,99205,HCPCS,outpatient,,,343.5,171.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient not requiring a physician,26599211,CDM,983,RC,99211,HCPCS,outpatient,,,24.5,12.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient requiring a physician,26599212,CDM,983,RC,99212,HCPCS,outpatient,,,56.5,28.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",26599213,CDM,983,RC,99213,HCPCS,outpatient,,,106.25,53.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 25 minutes",26599214,CDM,983,RC,99214,HCPCS,outpatient,,,162,81,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient, visit typically 40 minutes",26599215,CDM,983,RC,99215,HCPCS,outpatient,,,228.75,114.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UR SUBSEQUENT NRSG FAC PROB FOCUSED,26599307,CDM,983,RC,99307,HCPCS,outpatient,,,105,52.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC COUNSELING LUNG CANCER SCREEN LDCT,27000296,CDM,983,RC,G0296,HCPCS,outpatient,,,49.75,24.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC WOUND CLOSURE UTILIZING TISSUE ADHESS,27000900,CDM,983,RC,G0168,HCPCS,outpatient,,,69.5,34.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Physician telephone patient service, 5-10 minutes of medical discussion",27008441,CDM,983,RC,99441,HCPCS,outpatient,,,58.75,29.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 30 min",27008903,CDM,983,RC,99203,HCPCS,outpatient,,,160,80,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",27008913,CDM,983,RC,99213,HCPCS,outpatient,,,106.25,53.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Fine Needle Aspiration Biopsy without imaging,27010021,CDM,983,RC,10021,HCPCS,outpatient,,,375.75,187.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Incision and draige of abscess; simple or single and complex or multiple,27010060,CDM,983,RC,10060,HCPCS,outpatient,,,298.5,149.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC INC DRAIN ABSCESS MULTIPLE,27010061,CDM,983,RC,10061,HCPCS,outpatient,,,519.5,259.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC INC DRAIN PILONIDAL CYST SIMPLE,27010080,CDM,983,RC,10080,HCPCS,outpatient,,,305,152.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC INC REMOVE FOR BODY SIMPLE,27010120,CDM,983,RC,10120,HCPCS,outpatient,,,357.25,178.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC INC REMOVE FOR BODY COMPLICATED,27010121,CDM,983,RC,10121,HCPCS,outpatient,,,705.75,352.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Incision and draige of hematoma, seroma or fluid collection",27010140,CDM,983,RC,10140,HCPCS,outpatient,,,417.75,208.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Puncture aspiration of abscess, hematoma, bulla, or cyst",27010160,CDM,983,RC,10160,HCPCS,outpatient,,,338.25,169.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of infected skin,27011000,CDM,983,RC,11000,HCPCS,outpatient,,,149.75,74.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC DEBRIDEMENT SKIN SUBCUT TISSUE,27011042,CDM,983,RC,11042,HCPCS,outpatient,,,210.5,105.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC DEBRIDEMENT SUBQ E/ADDTL 20 SQ CM,27011045,CDM,983,RC,11045,HCPCS,outpatient,,,45.25,22.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC PARING CUTTING BEN HYPERKERATOTIC LES,27011055,CDM,983,RC,11055,HCPCS,outpatient,,,132.5,66.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Paring or cutting of benign hyperkeratotic lesion,27011056,CDM,983,RC,11056,HCPCS,outpatient,,,162.5,81.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC PARING CUT BEN HYPERKER LES > 4,27011057,CDM,983,RC,11057,HCPCS,outpatient,,,199,99.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC PUNCH BX SKIN SINGLE LESION,27011104,CDM,983,RC,11104,HCPCS,outpatient,,,118.25,59.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Removal of skin tags, multiple fibrocutaneous tags, any area",27011200,CDM,983,RC,11200,HCPCS,outpatient,,,216.5,108.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC SHAVING EPIDERMAL/DERM LES 1.1-2.0CM,27011307,CDM,983,RC,11307,HCPCS,outpatient,,,179.75,89.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC EXCISION BEN 2.1 TO 3.0 CM,27011403,CDM,983,RC,11403,HCPCS,outpatient,,,354.75,177.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC EXCISION BEN <.5 CM,27011420,CDM,983,RC,11420,HCPCS,outpatient,,,307.25,153.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC TRIMMING OF NONDYSTROPHIC ILS ANY #,27011719,CDM,983,RC,11719,HCPCS,outpatient,,,60.5,30.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC DEBRIDEMENT IL 1-5,27011720,CDM,983,RC,11720,HCPCS,outpatient,,,88.25,44.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Separation and removal of the entire il plate or a portion of il plate,27011730,CDM,983,RC,11730,HCPCS,outpatient,,,273.5,136.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC SUBUNGUAL HEMATOMA EVAC,27011740,CDM,983,RC,11740,HCPCS,outpatient,,,84,42,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC WEDGE EXCISION SKIN,27011765,CDM,983,RC,11765,HCPCS,outpatient,,,329.25,164.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Simple repair of superficial wounds of scalp, neck, axillae, exterl genitalia, trunk and/or extremities",27012001,CDM,983,RC,12001,HCPCS,outpatient,,,285.75,142.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC SIMP RPR SUPERFICIAL WD 2.6 TO 7.5 CM,27012002,CDM,983,RC,12002,HCPCS,outpatient,,,305.75,152.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC SIMP RPR SUPERFICIAL WD 7.5 TO 12.5 C,27012004,CDM,983,RC,12004,HCPCS,outpatient,,,256.25,128.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC LAC REPAIR >30 CM,27012007,CDM,983,RC,12007,HCPCS,outpatient,,,891.25,445.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes",27012011,CDM,983,RC,12011,HCPCS,outpatient,,,304.5,152.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC SIMP RPR SUPERF WD FACE EAR2.6-5.0 CM,27012013,CDM,983,RC,12013,HCPCS,outpatient,,,239.75,119.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC LAYER CLOSE WOUNDS 2.6 TO 7.5 CM,27012042,CDM,983,RC,12042,HCPCS,outpatient,,,356.5,178.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC INIT TRT FIRST DEG BURN LOCAL,27016000,CDM,983,RC,16000,HCPCS,outpatient,,,139,69.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC DRESS AND OR  DEBRIDE < 5%,27016020,CDM,983,RC,16020,HCPCS,outpatient,,,108.25,54.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC DRESS AND OR  DEBRIDE MED 5 TO 10%,27016025,CDM,983,RC,16025,HCPCS,outpatient,,,307.75,153.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of 1-14 common or plantar warts,27017110,CDM,983,RC,17110,HCPCS,outpatient,,,167.75,83.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Destruction of >15 common or plantar warts,27017111,CDM,983,RC,17111,HCPCS,outpatient,,,209.5,104.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Chemical destruction of pre-cancerous lesions of the skin,27017250,CDM,983,RC,17250,HCPCS,outpatient,,,98.75,49.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a small joint/bursa without ultrasound,27020600,CDM,983,RC,20600,HCPCS,outpatient,,,114,57,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a large joint/bursa without ultrasound,27020605,CDM,983,RC,20605,HCPCS,outpatient,,,92.75,46.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a major joint/bursa without ultrasound,27020610,CDM,983,RC,20610,HCPCS,outpatient,,,112.75,56.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC CLOSED TX RAD HEAD SUBL CHD,27024640,CDM,983,RC,24640,HCPCS,outpatient,,,423,211.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC REMOVE FOR BODY INTRASAL,27030300,CDM,983,RC,30300,HCPCS,outpatient,,,488.75,244.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC CONTROL SAL HEMORR ANTERIOR SIMPL,27030901,CDM,983,RC,30901,HCPCS,outpatient,,,238.5,119.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC SAL HEMOR / BILATERAL COMPLEX,27030903,CDM,983,RC,30903,HCPCS,outpatient,,,770.25,385.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC DRAIGE ABSCESS DENTOALVEOLAR STRUCT,27041800,CDM,983,RC,41800,HCPCS,outpatient,,,596.75,298.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Draining or injecting medication into a small joint/bursa without ultrasound,27050600,CDM,983,RC,20600,HCPCS,outpatient,,,227.75,113.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC INSERT NON-INDWELLING BLADDER CATH,27051701,CDM,983,RC,51701,HCPCS,outpatient,,,191.75,95.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC INSERT TEMP BLADDER CATH,27051702,CDM,983,RC,51702,HCPCS,outpatient,,,237.5,118.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC INCISION AND DRAIGE BARTHOLIN GLAND,27056420,CDM,983,RC,56420,HCPCS,outpatient,,,358.25,179.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC INJ TRIGEMIL NERVE,27064400,CDM,981,RC,64400,HCPCS,outpatient,,,154,77,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC INJ FACIAL NERVE,27064402,CDM,983,RC,64402,HCPCS,outpatient,,,374.5,187.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC REMOVAL FOR BODY EXT EYE CONJ SUPER,27065205,CDM,983,RC,65205,HCPCS,outpatient,,,111.75,55.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC RMV FOR BDY CONJ EMB,27065210,CDM,983,RC,65210,HCPCS,outpatient,,,180.25,90.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC REMOVAL FOR BODY CORNEAL WO SLIT,27065220,CDM,983,RC,65220,HCPCS,outpatient,,,82.25,41.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC DRAIN EYELID LESION,27067700,CDM,981,RC,67700,HCPCS,outpatient,,,663.25,331.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC REMOVAL FORG BODY EYELID,27067938,CDM,983,RC,67938,HCPCS,outpatient,,,579,289.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC DRAIN EXT AUD CAL,27069020,CDM,983,RC,69020,HCPCS,outpatient,,,589.25,294.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC FOREIGN BDY REMOVAL AUDITORY CAL,27069200,CDM,983,RC,69200,HCPCS,outpatient,,,110.25,55.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC REMOVAL IMPACTED CERUMEN IRRIG LAVAGE,27069209,CDM,983,RC,69209,HCPCS,outpatient,,,22.75,11.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Removal of ear wax from one or both ears,27069210,CDM,983,RC,69210,HCPCS,outpatient,,,101.5,50.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC EKG INTERP,27093010,CDM,983,RC,93010,HCPCS,outpatient,,,25.5,12.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC INHALATION TRT W AEROSOL MED,27094664,CDM,983,RC,94664,HCPCS,outpatient,,,34.5,17.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC CALITH REPOSITIONING MANEUVER,27095992,CDM,983,RC,95992,HCPCS,outpatient,,,137.5,68.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Debridement (for example, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps)",27097597,CDM,983,RC,97597,HCPCS,outpatient,,,127,63.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC WOUND VAC 50  SQCM OR LESS,27097605,CDM,983,RC,97605,HCPCS,outpatient,,,81.75,40.88,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC GLOBAL,27099024,CDM,969,RC,99024,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 10 minutes",27099202,CDM,983,RC,99202,HCPCS,outpatient,,,154,77,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office or other outpatient visit, typically 30 min",27099203,CDM,983,RC,99203,HCPCS,outpatient,,,222.25,111.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 45 min",27099204,CDM,983,RC,99204,HCPCS,outpatient,,,222.25,111.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"New patient office of other outpatient visit, typically 60 min",27099205,CDM,983,RC,99205,HCPCS,outpatient,,,343,171.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient not requiring a physician,27099211,CDM,983,RC,99211,HCPCS,outpatient,,,46,23,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Outpatient visit of established patient requiring a physician,27099212,CDM,983,RC,99212,HCPCS,outpatient,,,90.25,45.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",27099213,CDM,983,RC,99213,HCPCS,outpatient,,,148.5,74.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 25 minutes",27099214,CDM,983,RC,99214,HCPCS,outpatient,,,222.25,111.13,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient, visit typically 40 minutes",27099215,CDM,983,RC,99215,HCPCS,outpatient,,,300.75,150.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC CRITICAL CARE 1ST 30 TO 74 MIN,27099291,CDM,983,RC,99291,HCPCS,outpatient,,,502.75,251.38,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Initial new patient preventive medicine evaluation (40?4 years),27099386,CDM,983,RC,99386,HCPCS,outpatient,,,220,110,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC SMOKING COUNSEL 3-10 MIN,27099406,CDM,983,RC,99406,HCPCS,outpatient,,,27.25,13.63,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC SMOKING COUNSEL>10 MIN,27099407,CDM,983,RC,99407,HCPCS,outpatient,,,54.5,27.25,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
UC SCHOOL OR SPORTS PHYSICAL PRIVATE PAY,27099429,CDM,983,RC,99429,HCPCS,outpatient,,,25,12.5,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Established patient office or other outpatient visit, typically 15 minutes",27099999,CDM,983,RC,99213,HCPCS,outpatient,,,103.5,51.75,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ACO DISCHARGE MEDICATIONS RECONCILED,80500001,CDM,969,RC,1111F,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ACO NO FALLS ONE FALL WITHOUT INJURY,80500002,CDM,969,RC,1101F,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ACO FALL RISK ASSESSMENT DOCUMENTED,80500003,CDM,969,RC,3288F,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ACO FLU IMMUNIZATION RECEIVED,80500005,CDM,969,RC,G8482,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ACO FLU VACCINE NOT ADMINISTERED,80500006,CDM,969,RC,G8483,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ACO ABNORMALLY LOW BMI FOLLOW-UP,80500007,CDM,969,RC,G8418,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ACO BMI NORMAL,80500008,CDM,969,RC,G8420,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ACO CURRENT TOBACCO SMOKER,80500011,CDM,969,RC,1034F,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ACO CURRENT SMOKELESS TOBACCO USER,80500012,CDM,969,RC,1035F,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ACO POSITIVE DEPRESSION SCREEN FOLLOW-UP,80500013,CDM,969,RC,G8431,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ACO NEGATIVE DEPRESSION SCREEN,80500014,CDM,969,RC,G8510,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ACO COLORECTAL CANCER SCREENING RESULTS,80500016,CDM,969,RC,3017F,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ACO COLORECTAL CANCER FLEX SIGMOIDOSCOPY,80500017,CDM,969,RC,G0104,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Colorectal cancer screening; colonoscopy on individual at high risk,80500018,CDM,969,RC,G0105,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ACO COLORECTAL CANCER SIGMOIDOSCOPY BE,80500019,CDM,969,RC,G0106,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
"Colorectal cancer screening; altertive to g0105, screening colonoscopy, barium enema",80500020,CDM,969,RC,G0120,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk,80500021,CDM,969,RC,G0121,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ACO COLORECTAL CANCER FECAL OCCULT BLOOD,80500022,CDM,969,RC,G0328,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ACO COLORECTAL CANCER D OCCULT HGB,80500023,CDM,969,RC,G0464,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ACO BREAST CANCER SCREENING RESULTS,80500026,CDM,969,RC,3014F,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ACO DEPRESSION REMISSION INDICATED,80500033,CDM,969,RC,G9393,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ACO DILATED RETIL EYE EXAM,80500034,CDM,969,RC,2022F,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ACO LOW RISK FOR RETINOPATHY,80500035,CDM,969,RC,3072F,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CMS COGNITION ASSESSED AND REVIEWED,80500036,CDM,969,RC,1494F,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CMS CERVICAL CANCER SCREENING RESULTS,80500037,CDM,969,RC,3015F,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CMS ALCOHOL SUBSTANCE INTERVENTION BRIEF,80500038,CDM,969,RC,G0396,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
CMS ALCOHOL SUBSTANCE INTERVENTION,80500039,CDM,969,RC,G0397,HCPCS,outpatient,,,,,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ACO ADVANCE CARE PLAN DOCUMENTED,80501123,CDM,969,RC,1123F,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
ACO ADVANCE CARE PLAN NO DOCUMENT,80501124,CDM,969,RC,1124F,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
QR BMI DOCUMENTED,80503008,CDM,969,RC,3008F,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
QR HGB A1C <7,80503044,CDM,969,RC,3044F,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
QR HGB A1C >9.0,80503046,CDM,969,RC,3046F,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
QR HGB A1C 7.0-8.0,80503051,CDM,969,RC,3051F,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
QR HGB A1C 8.0-9.0,80503052,CDM,969,RC,3052F,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
QR BP SYSTOLIC < 130,80503074,CDM,969,RC,3074F,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
QR BP SYSTOLIC 130-139,80503075,CDM,969,RC,3075F,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
QR BP SYSTOLIC = > 140,80503077,CDM,969,RC,3077F,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
QR BP DIASTOLIC < 80,80503078,CDM,969,RC,3078F,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
QR BP DIASTOLIC 80-90,80503079,CDM,969,RC,3079F,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,
QR BP DIASTOLIC = OR > 90,80503080,CDM,969,RC,3080F,HCPCS,outpatient,,,0.01,0.01,,,,,,other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable, ,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,,,Other,Not Separately reimbursable,,,